Acute lobar nephronia in the pediatric patient. Case report
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Abstract
Background: Acute focal nephritis is a renal inflammation of bacterial origin, without liquefaction, that affects one or more renal lobes. This entity is underdiagnosed, and few cases are described in the literature. Its recognition is essential due to its relationship with urosepsis and renal scars. It can simulate a kidney tumor. It is associated with malformations of the urinary tract. Diagnostic images are of great value, with ultrasound and tomography being the images of choice. Treatment consists of antibiotic therapy, with generally good evolution. Case report: Male patient, six years old, with two weeks of daily fever, without other symptoms. Regular physical exam. Complete blood count with leukocytosis and neutrophilia. The abdominal ultrasound showed a non-specific renal lesion in the upper left pole. Contrast-enhanced abdominal tomography showed a heterogeneous left renal tumor with poorly defined borders, compromising the renal cortex, capsule, and perirenal space, without calcifications, collections, and evident tumor characteristics, without enhancement with contrast medium. MRI of the abdomen contrasted with a lesion compatible with an inflammatory process. Management with amikacin, cephalothin, and clindamycin for three weeks, with good evolution. Control images with a decreased lesion. Conclusion: Acute focal nephritis is a rare entity in pediatrics. Its recognition is essential due to its impact on renal function. The images of choice are ultrasound and CT. Antibiotic management is recommended for three weeks, the study of associated urinary malformations, ultrasound follow-up, and DMSA scintigraphy to evaluate scars.
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