Division of Nephrology, Osaka Saiseikai Izuo Hospital, 3-4-5 Kitamura, Taisho-ku, Osaka, 551-0032, Japan.
CEN Case Rep. 2022 Aug;11(3):386-390. doi: 10.1007/s13730-022-00688-0. Epub 2022 Feb 6.
Acute focal bacterial nephritis (AFBN) refers to the bacterial infection of the renal parenchyma without abscess formation. Although AFBN has mainly been reported in pediatric patients, it may be underdiagnosed in adults as it resembles acute pyelonephritis in its clinical presentation. However, the symptoms suggesting acute abdomen is an important clue to diagnose AFBN, which requires additional imaging studies such as contrast-enhanced computed tomography (CECT). Here, we present the case of a 49-year-old female presenting to our emergency room with acute abdomen as well as acute kidney injury (AKI). CECT was performed to rule out critical etiologies of severe abdominal pain and the results revealed multifocal wedge-shaped shadows in the right kidney and diffuse enlargement of bilateral kidneys. We diagnosed the patient with AFBN and treated her through temporal hemodialysis (two sessions) and antibiotics for 23 days. Although AKI associated with AFBN has rarely been reported, her renal dysfunction and other symptoms were completely improved. In conclusion, clinicians should be aware of AFBN and be cautious to avoid the unnecessary invasive interventions.
急性局灶性细菌性肾炎（AFBN）是指肾实质的细菌感染而无脓肿形成。尽管 AFBN 主要在儿科患者中报道，但由于其临床表现类似于急性肾盂肾炎，因此在成人中可能被漏诊。然而，提示急性腹痛的症状是诊断 AFBN 的重要线索，这需要额外的影像学检查，如增强计算机断层扫描（CECT）。在这里，我们报告了一例 49 岁女性因急性腹痛和急性肾损伤（AKI）就诊于我们的急诊室。为了排除严重腹痛的危急病因，进行了 CECT，结果显示右肾有多发性楔形阴影和双侧肾脏弥漫性肿大。我们诊断该患者为 AFBN，并通过暂时血液透析（两次）和 23 天的抗生素治疗。虽然与 AFBN 相关的 AKI 很少被报道，但她的肾功能障碍和其他症状完全改善。总之，临床医生应该意识到 AFBN 的存在，并谨慎避免不必要的侵入性干预。
