Brummer Hannah, Wang Hongyue, Schwartz George J
Division of Nephrology, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
Division of Nephrology, Department of Pediatrics, UBMD/Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA.
Pediatr Nephrol. 2025 Jul;40(7):2277-2285. doi: 10.1007/s00467-025-06708-2. Epub 2025 Feb 13.
Pyelonephritis is the most common serious bacterial infection in pediatric patients. Several electrolyte abnormalities have been described with pyelonephritis, including metabolic acidosis. We sought to describe the frequency and clinical significance of metabolic acidosis in pediatric patients with acute Escherichia coli (E. coli) pyelonephritis, with comparison to parallel infection group of bacterial pneumonia.
This was a single-center, retrospective study of pediatric patients with pyelonephritis or pneumonia hospitalization. Nadir serum bicarbonate and anion gap values were collected, and baseline and recovery values when available. Serum electrolyte and creatinine values and markers of infection severity were recorded.
Ninety-four pyelonephritis and 95 pneumonia subjects were included. Pyelonephritis mean nadir bicarbonate was 20 (SD 3) mEq/L, statistically significantly lower than 21 (3) mEq/L in pneumonia. Corresponding anion gap was 16 (4) mEq/L in pyelonephritis, statistically significantly lower than 17 (3) mEq/L in pneumonia. There was significant correlation between acidosis and number of fever days in pyelonephritis and between acidosis and hospital length of stay in both groups.
This study demonstrated development of acidosis in 84% of patients with pyelonephritis and in 66% with pneumonia. The mechanism of acidosis appears to have a greater contribution from elevated anion gap in the pneumonia group compared to the pyelonephritis group. Lower nadir serum bicarbonate values are associated with longer hospital length of stay in both groups and greater number of fever days in the pyelonephritis patients.
肾盂肾炎是儿科患者中最常见的严重细菌感染。已有多项关于肾盂肾炎伴发的电解质异常的描述，包括代谢性酸中毒。我们试图描述急性大肠杆菌肾盂肾炎患儿代谢性酸中毒的发生率及其临床意义，并与细菌性肺炎平行感染组进行比较。
这是一项针对肾盂肾炎或肺炎住院患儿的单中心回顾性研究。收集最低血清碳酸氢盐和阴离子间隙值，以及可用时的基线值和恢复值。记录血清电解质、肌酐值和感染严重程度指标。
纳入94例肾盂肾炎患者和95例肺炎患者。肾盂肾炎患者的平均最低碳酸氢盐为20（标准差3）mEq/L，在统计学上显著低于肺炎患者的21（3）mEq/L。肾盂肾炎患者相应的阴离子间隙为16（4）mEq/L，在统计学上显著低于肺炎患者的17（3）mEq/L。肾盂肾炎患者的酸中毒与发热天数之间以及两组患者的酸中毒与住院时间之间均存在显著相关性。
本研究表明，84%的肾盂肾炎患者和66%的肺炎患者发生了酸中毒。与肾盂肾炎组相比，肺炎组酸中毒的机制似乎更多地来自阴离子间隙升高。两组患者中，最低血清碳酸氢盐值较低均与住院时间较长相关，而在肾盂肾炎患者中则与发热天数较多相关。
