Pediatric Pyelonephritis Differential Diagnoses

  • Author: Robert W Tolan Jr, MD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Feb 9, 2012
 
 

Diagnostic Considerations

UTI and pyelonephritis must be considered in young pediatric patients with fever and/or nonspecific symptoms so that this fairly common diagnosis is not overlooked.Identification and treatment of acute pyelonephritis in the first 5-7 days significantly decreases the risk of renal scarring.

Conditions to be considered in the differential diagnosis of pyelonephritis include the following:

  • Concurrent pregnancy
  • Anatomic abnormalities of the urinary tract
  • Vesicoureteral reflux
  • Ureteropelvic junction obstruction
  • Posterior urethral valves
  • Ureterocele
  • Vaginitis
  • Fever of unknown origin
  • Pelvic inflammatory disease
  • Xanthogranulomatous pyelonephritis

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: Novartis Honoraria Speaking and teaching

Coauthor(s)

Stephen C Aronoff, MD  Waldo E Nelson Chair and Professor, Department of Pediatrics, Temple University School of Medicine

Stephen C Aronoff, MD is a member of the following medical societies: Pediatric Infectious Diseases Society and Society for Pediatric Research

Disclosure: Nothing to disclose.

Andrea CS McCoy, MD  Associate Professor of Pediatrics, Temple University School of Medicine; Chief Medical Officer, Jeanes Hospital

Andrea CS McCoy, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Leslie L Barton, MD Professor Emerita of Pediatrics, University of Arizona College of Medicine

Leslie L Barton, MD is a member of the following medical societies: American Academy of Pediatrics, Association of Pediatric Program Directors, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

References

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  2. Shaikh N, Ewing AL, Bhatnagar S, Hoberman A. Risk of renal scarring in children with a first urinary tract infection: a systematic review. Pediatrics. Dec 2010;126(6):1084-91. [Medline].

  3. Lundstedt AC, Leijonhufvud I, Ragnarsdottir B, et al. Inherited susceptibility to acute pyelonephritis: a family study of urinary tract infection. J Infect Dis. Apr 15 2007;195(8):1227-34. [Medline].

  4. Faust WC, Diaz M, Pohl HG. Incidence of post-pyelonephritic renal scarring: a meta-analysis of the dimercapto-succinic acid literature. J Urol. Jan 2009;181(1):290-7; discussion 297-8. [Medline].

  5. Bhat RG, Katy TA, Place FC. Pediatric urinary tract infections. Emerg Med Clin North Am. Aug 2011;29(3):637-53. [Medline].

  6. Williams GJ, Macaskill P, Chan SF, Turner RM, Hodson E, Craig JC. Absolute and relative accuracy of rapid urine tests for urinary tract infection in children: a meta-analysis. Lancet Infect Dis. Apr 2010;10(4):240-50. [Medline].

  7. Pecile P, Romanello C. Procalcitonin and pyelonephritis in children. Curr Opin Infect Dis. Feb 2007;20(1):83-7. [Medline].

  8. American Academy of Pediatrics. Urinary Tract Infection: Clinical Practice Guideline for the Diagnosis and Management of the Initial UTI in Febrile Infants and Children 2 to 24 Months. Pediatrics. Aug 28 2011;[Medline].

  9. Wang YT, Chiu NT, Chen MJ, et al. Correlation of renal ultrasonographic findings with inflammatory volume from dimercaptosuccinic acid renal scans in children with acute pyelonephritis. J Urol. Jan 2005;173(1):190-4; discussion 194. [Medline].

  10. [Guideline] Subcommittee on Urinary Tract Infection; Steering Committe on Quality Improvement and Management. Urinary Tract Infection: Clinical Practice Guideline for the Diagnosis and Management of the Initial UTI in Febrile Infants and Children 2 to 24 Months. Pediatrics. Aug 28 2011;[Medline].

  11. Lee YJ, Lee JH, Park YS. Risk Factors for Renal Scar Formation in Infants With First Episode of Acute Pyelonephritis: A Prospective Clinical Study. J Urol. Jan 18 2012;[Medline].

  12. Kovanlikaya A, Okkay N, Cakmakci H, et al. Comparison of MRI and renal cortical scintigraphy findings in childhood acute pyelonephritis: preliminary experience. Eur J Radiol. Jan 2004;49(1):76-80. [Medline].

  13. Kavanagh EC, Ryan S, Awan A, et al. Can MRI replace DMSA in the detection of renal parenchymal defects in children with urinary tract infections?. Pediatr Radiol. Mar 2005;35(3):275-81. [Medline].

  14. Montini G, Rigon L, Zucchetta P, et al. Prophylaxis after first febrile urinary tract infection in children? A multicenter, randomized, controlled, noninferiority trial. Pediatrics. Nov 2008;122(5):1064-71. [Medline].

  15. Hodson EM, Willis NS, Craig JC. Antibiotics for acute pyelonephritis in children. Cochrane Database Syst Rev. Oct 17 2007;CD003772. [Medline].

  16. Williams GJ, Wei L, Lee A, Craig JC. Long-term antibiotics for preventing recurrent urinary tract infection in children. Cochrane Database Syst Rev. Jul 19 2006;3:CD001534. [Medline].

  17. Garin EH, Olavarria F, Garcia Nieto V, et al. Clinical significance of primary vesicoureteral reflux and urinary antibiotic prophylaxis after acute pyelonephritis: a multicenter, randomized, controlled study. Pediatrics. Mar 2006;117(3):626-32. [Medline].

  18. Bloomfield P, Hodson EM, Craig JC. Antibiotics for acute pyelonephritis in children. Cochrane Database Syst Rev. Jan 25 2005;CD003772. [Medline].

  19. Huang YY, Chen MJ, Chiu NT, Chou HH, Lin KY, Chiou YY. Adjunctive Oral Methylprednisolone in Pediatric Acute Pyelonephritis Alleviates Renal Scarring. Pediatrics. Aug 15 2011;[Medline].

 
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Application of low-risk criteria and approach for the febrile infant: A reasonable approach for treating febrile infants younger than 3 months who have a temperature of greater than 38°C.
 
 
 
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