Complications
Therapy should be stopped if rash is urticarial.
Initiation of a different class of antibiotics, based on susceptibility testing, should be considered.
Risk factors for renal abscess include underlying urinary tract abnormalities, primary infection elsewhere with bacteraemia, preceding urinary tract surgery, immunodeficiency, trauma to the kidney, and diabetes mellitus.
In patients presenting with renal abscess, percutaneous aspiration of the abscess, performed by an interventional radiologist, is useful to identify the pathogen and guide therapy.
A paediatric infectious disease specialist and paediatric nephrologists should be consulted in cases where open surgical drainage is being considered.
Follow-up can consist of serial ultrasounds and monitoring of inflammatory markers (C-reactive protein).
In most children with lobar nephronia, prolonged parenteral antimicrobial therapy is usually curative.
Sepsis is more common in neonates, premature infants, and infants with urinary symptoms.
Stool should be tested for Clostridium difficile. If the result is positive, vancomycin, fidaxomicin, or metronidazole is added.
Causative antibiotic is stopped if possible.
Scarring occurs secondary to renal parenchymal involvement (pyelonephritis).
It has increased risk of occurrence with delay in treatment, increased number of episodes of pyelonephritis, and with acute lobar nephronia.[91] Children with high-grade vesicoureteral reflux commonly have associated renal dysplasia, which is indistinguishable from renal scars on the baseline dimercaptosuccinic acid (DMSA) scan. However, progression or new scarring on repeat DMSA scan suggests acquired renal scarring.
Increased areas of renal scarring from pyelonephritis may lead to decreased amounts of functional renal tissue and the development of renal insufficiency with time.
A childhood history of clinically evident kidney disease was associated with a significantly increased risk (hazard ratio 4.19) of end-stage renal disease, even if renal function was apparently normal in adolescence. This suggests that kidney injury or structural abnormality in childhood has long-term sequelae.[92]
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