title: Acute focal bacterial nephritis is associated with invasive diagnostic procedures - a cohort of 138 cases extracted through a systematic review.
abstract: Acute focal bacterial nephritis (AFBN) is a rare disease currently described only in case reports and small case series. In this study we summarize the clinical features of AFBN as has been documented in the literature and draw recommendations on the proper diagnosis and therapy.
  
  
  
  A systematic literature review was undertaken in PUBMED, Web of Science and The Cochrane Library online databases for relevant literature on AFBN in adults.
  
  
  
  Literature review revealed a total of 38 articles according to our inclusion criteria, of which we could extract data from 138 cases of AFBN. Fever (98%) and flank pain (80%) were most commonly reported symptoms. E. coli was the most frequent pathogen. Diagnosis was set by CT and/or MRI (52%) with or without sonography or by sonography alone (20%) as well as by sonography combined with IVU. In total, sonography was applied in 83% of cases. All but one patient received antibiotic treatment. Kidney lesions were occasionally mistaken for neoplasms or renal abscesses and as a result, cases were subjected to percutaneous puncture (12.3%), surgical exploration (5.1%) and partial or radical nephrectomy (4.4%). Four cases (2.9%) developed a renal abscess.
  
  
  
  The diagnosis of AFBN is set by characteristic clinico-radiological findings. Differential diagnoses of this interstitial bacterial infection include renal abscess and tumor. Correct diagnosis is occasionally impeded by atypical symptoms. Invasive diagnostic and therapeutic procedures should be limited as the majority of cases respond well to conservative treatment.
authors.affiliation: Department of Urology, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany. nadine.sieger@hotmail.com.
authors.forename: Nadine
authors.identifier: 0000-0001-7054-3607
authors.initials: N
authors.lastname: Sieger
authors.affiliation: Department of Urology, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.|Department of Urology, University Hospital of Patras, Rio 265 04, Patras, Greece.
authors.forename: Iason
authors.initials: I
authors.lastname: Kyriazis
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Schaudinn
authors.affiliation: Department of Urology, University Hospital of Patras, Rio 265 04, Patras, Greece.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Kallidonis
authors.affiliation: Department of Urology, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Neuhaus
authors.affiliation: Department of Urology, University Hospital of Patras, Rio 265 04, Patras, Greece.
authors.forename: Evangelos N
authors.initials: EN
authors.lastname: Liatsikos
authors.affiliation: Department of Urology, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
authors.forename: Roman
authors.initials: R
authors.lastname: Ganzer
authors.affiliation: Department of Urology, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
authors.forename: Jens-Uwe
authors.initials: JU
authors.lastname: Stolzenburg
mesh_terms: D018784:Abdominal Abscess / Q000175:diagnosis; D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology; D015331:Cohort Studies; D003937:Diagnosis, Differential; D004926:Escherichia coli; D006801:Humans; D009393:Nephritis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology; D014463:Ultrasonography; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: Focal nephritis; Pyelonephritis; Renal infection; Upper urinary tract infection