title: Comparison of acute lobar nephronia and acute pyelonephritis in children: a single-center clinical analysis in southern taiwan.
abstract: BACKGROUND
  Patients with acute lobar nephronia (ALN) require a longer duration of antimicrobial treatment than those with acute pyelonephritis (APN), and ALN is associated with renal scarring. The aim of this study was to provide an understanding of ALN by comparing the clinical features of pediatric patients with ALN and APN.
  
  
  METHODS
  We enrolled all of the patients with ALN (confirmed by computed tomography) admitted to our hospital from 1999 to 2012 in the ALN group. In addition, each patient diagnosed with APN who was matched for sex, age, and admission date to each ALN patient was enrolled in the APN group. The medical charts of patients in these two groups were retrospectively reviewed and analyzed for comparison.
  
  
  RESULTS
  The fever duration after hospitalization in the ALN group and the APN group were 4.85 ± 2.33 days and 2.30 ± 1.47 days respectively. The microbiological distributions and the majority of susceptibilities were similar in the ALN and APN groups. The majority of clinical manifestations are nonspecific and unreliable for the differentiation of ALN and APN. The patients with ALN were febrile for longer after antimicrobial treatment, had more nausea/vomiting symptoms, higher neutrophil count, bandemia, and C-reactive protein (CRP) levels, and lower platelet count (all p < 0.05). In multivariate analysis, initial CRP levels, nausea/vomiting symptoms, and fever duration after admission were independent variables with statistical significance to predict ALN. Severe nephromegaly occurred significantly more in the ALN group than in the APN group (p = 0.022).
  
  
  CONCLUSIONS
  The majority of clinical manifestations, laboratory findings, and microbiological features are similar between patients with ALN and APN. Clinicians should keep a high index of suspicion regarding ALN, particularly for those with ultrasonographic nephromegaly, initial higher CRP, nausea/vomiting, and fever for > 5 days after antimicrobial treatment.
authors.affiliation: Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Pediatrics, Pingtung Branch of Kaohsiung Veterans General Hospital, Pingtung, Taiwan.
authors.forename: Wan-Ling
authors.initials: WL
authors.lastname: Chen
authors.affiliation: Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: I-Fei
authors.initials: IF
authors.lastname: Huang
authors.affiliation: School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung, Taiwan; Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan.
authors.forename: Jiun-Ling
authors.initials: JL
authors.lastname: Wang
authors.affiliation: Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan.
authors.forename: Chih-Hsin
authors.initials: CH
authors.lastname: Hung
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Jer-Shyung
authors.initials: JS
authors.lastname: Huang
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Yao-Shen
authors.initials: YS
authors.lastname: Chen
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Susan Shin-Jung
authors.initials: SS
authors.lastname: Lee
authors.affiliation: Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Kai-Sheng
authors.initials: KS
authors.lastname: Hsieh
authors.affiliation: Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Chia-Wan
authors.initials: CW
authors.lastname: Tang
authors.affiliation: Department of Pediatrics, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan.
authors.forename: Jen-Hung
authors.initials: JH
authors.lastname: Chien
authors.affiliation: Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan. Electronic address: yhchiou@vghks.gov.tw.
authors.forename: Yee-Hsuan
authors.initials: YH
authors.lastname: Chiou
authors.affiliation: Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan. Electronic address: mfcheng@vghks.gov.tw.
authors.forename: Ming-Fang
authors.initials: MF
authors.lastname: Cheng
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D002097:C-Reactive Protein; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011704:Pyelonephritis / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies; D013624:Taiwan; D014057:Tomography, X-Ray Computed
chemical_list: D002097:C-Reactive Protein
keywords: Escherichia coli; acute lobar nephronia; acute pyelonephritis; children; urinary tract infection