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Minerva Medica 2019 June;110(3):232-7

DOI: 10.23736/S0026-4806.19.06002-6


lingua: Inglese

Pyuria and microbiology in acute bacterial focal nephritis: a systematic review

Simone JANETT 1, 2, Gregorio P. MILANI 3, 4 , Pietro B. FARÉ 1, Samuele RENZI 2, 5, Olivier GIANNINI 6, Mario G. BIANCHETTI 2, 7, Sebastiano A. LAVA 8

1 Department of Internal Medicine, Ente Ospedaliero Cantonale, Locarno, Switzerland; 2 Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland; 3 Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; 4 Department of Clinical Sciences and Community Health, Università degli Studi, Milan, Italy; 5 Division of Hematology and Oncology, the Hospital for Sick Children, Toronto, ON, Canada; 6 Department of Internal Medicine, Ente Ospedaliero Cantonale, Mendrisio, Switzerland; 7 Università della Svizzera Italiana, Lugano, Switzerland; 8 Unit of Pediatric Cardiology, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

INTRODUCTION: Presentation and imaging findings of acute focal bacterial nephritis, a localized renal infection not containing drainable pus, have been extensively addressed. The aim of this review was to assess the prevalence of cases without pyuria or bacteriuria and the spectrum of microorganisms underlying this condition.
EVIDENCE ACQUISITION: We conducted a systematic review of the literature in the National Library of Medicine and Excerpta Medica databases. For the final analysis, we retained 54 reports published between 1981 and 2018 describing 251 patients affected by focal bacterial nephritis, who have been specifically investigated with respect to urinalysis and standard bacterial cultures. They were 177 (102 females and 75 males) subjects ≤20 and 74 (57 females and 17 males) >20 years of age.
EVIDENCE SYNTHESIS: Pyuria and bacteriuria were absent in 33 cases, while pyuria was not associated with bacteriuria in 5 further cases. The vast majority of culture-positive cases were caused by Enterobacteriaceae (slightly less than 80%) and Pseudomonas species (approximately 10%). Enterococcus species and Staphylococcus aureus were isolated in slightly more than 10% of the cases.
CONCLUSIONS: A large subset of patients affected by focal bacterial nephritis present without pyuria and significant bacteriuria. The initial management consists of broad-spectrum antimicrobials with high tissue penetration, active against Enterobacteriaceae, Pseudomonas species, Enterococcus species and Staphylococcus aureus.

KEY WORDS: Nephritis - Microbiology - Pyuria - Urinalysis

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