急性局灶性细菌性肾炎的临床特征

Clinical features of children with acute focal bacterial nephritis

目的 了解罹患急性局灶性细菌性肾炎（AFBN）患儿的临床特征,评估其诊治要点,避免漏诊误治.方法 分析2006年1月至2012年12月深圳市儿童医院收治的12例AFBN患儿临床资料,针对本病的临床特点及诊疗方案进行归纳总结.结果 本组12例确诊为AFBN的患儿中＜1岁7例（58.3％）,首发及主要症状为发热,多缺乏典型的泌尿道定位症状和体征；外周血象、CRP及降钙素原等炎性指标较一般泌尿道感染升高幅度更为明显.5例合并肾盂输尿管扩张,1例合并膀胱输尿管返流.血培养：金黄色葡萄球菌1例,大肠埃希菌2例,表皮葡萄球菌1例.尿培养：大肠埃希菌4例,大肠埃希菌＋粪肠球菌1例,金黄色葡萄球菌1例,白色假丝酵母菌1例.泌尿系超声：患肾增大,肾实质回声增强或不均匀,肾实质内常可见多个低回声区,边界模糊不清.CT或MRI扫描：患肾实质内典型的楔形病灶或类圆形低灌注区.治疗采用广谱的抗菌治疗,根据药敏试验针对性选择抗生素,疗程14～ 55 d.11例随访患儿经保守治疗临床治愈.结论 AFBN患儿中婴儿发病率较高,应高度警惕是否存在泌尿道畸形、肾盂输尿管扩张或VUR等合并症,泌尿系影像学检查是确诊本病的必要手段.最常见病原菌为大肠埃希菌,且耐药现象严重,保守治疗效果良好.

Objective To investigate the clinical features of acute focal bacterial nephritis （AFBN） in children,and to evaluate the strategy of diagnosis and therapy on children with AFBN,avoiding any blind spots of clinical treatment.Methods The clinical features of 12 cases of AFBN children admitted in Shenzhen Children＇s Hospital from Jan.2006 to Dec.2012 were analyzed.The clinical features and treatment strategy of AFBN were summarized.ResultsSeven in 12 cases（58.3％） were younger than 1 year old,fever was the initial and cardinal symptom,most cases were lack of typical or local urinary symptoms and signs.Peripheral blood leukoeytes,C-reactive protein and procalcitonin were highly increased in all cases,comparing with simple urinary tract infection.Five cases combined with pyeloureterectasis.One case combined with vesicoureteral reflux （VUR）.Blood culture：staphylococcus aureus （1 case）,staphylococcus epidermidis （1 case）,E.Coli （2 cases）.Urine culture：E.Coli （4 cases）,E.Coli and enterococcus faecalis （1case）,staphylococcus aureus （1 case）,white candida yeast （1 case）,mixed flora （2 cases）.Urinary ultrasound：renal swelling was showed in involved kidney.Echo of renal parenchyma were enhanced or nonuniform,multiple hypoechoic area were easily visible in involved renal parenchyma,with boundary ambiguity.CT or MRI scan：typical findings were reducing perfusion with multiple wedge-shaped or quasi-circular lesions.Broad-spectrum antibacterial treatment was effective and necessary.The medication of antimicrobial was under the guidance of drug susceptibility test.The average course of treatment was 14-55 days.Eleven cases were cured by conservative treatment.Conclusions The morbility of AFBN in young infants are high.The combination of urinary tract deformity,pyeloureterectasis or VUR should be highly vigilant in AFBN children.Imageological inspection of urinary tract is the necessary method on AFBN diagnosis.The major pathogen is E.Coli,which shows a high resistance to antibiotics.Conservative antibacterial treatment is effective in AFBN.