Streptococcus agalactiae or group B streptococcus (GBS) is associated with infectionsin neonates and pregnant women. Herein, we describe a rare case of GBSrenal abscess with peritonitis and pleural effusion in a 17-year-old girl with type 1diabetes mellitus. The girl was admitted due to fever and right flank pain. Laboratoryfindings included leukocytosis and increased C-reactive protein level anderythrocyte sedimentation rate. Her serum glucose level was 484 mg/dL. Urinalysisshowed no pyuria. Renal sonography revealed parenchymal swelling in the rightkidney. The patient was administered intravenous cefotaxime. Urine and bloodcultures were negative. Fever seemed to improve, but the following day, she complainedof abdominal pain and fever. Antibiotic was switched to imipenem, andabdominal and pelvic CT revealed a ruptured right renal abscess, peritonitis, andbilateral pleural effusion with atelectasis. Pigtail catheter drainage of the abscesswas performed. Culture from the abscess was positive for GBS, and fever subsided2 days after the drainage. She was discharged with oral cefixime. The clinical courseof urinary tract infections (UTIs) can be atypical in patients with diabetes, and GBScan be a cause of UTIs. Prompt diagnosis and management are necessary to preventcomplications in patients showing atypical courses.

Neutrophil gelatinase-associated lipocalin (NGAL) has emerged as one of the most promising biomarkers of renal epithelial injury. Numerous studies have presented the diagnostic and prognostic utility of urinary and plasma NGAL in patients with acute kidney injury, chronic kidney disease, renal injury after kidney transplantation, and other renal diseases. NGAL is a member of the lipocalin family that is abundantly expressed in neutrophils and monocytes/macrophages and is a mediator of the innate immune response. The biological significance of NGAL to hamper bacterial growth by sequestering iron-binding siderophores has been studied in a knock-out mouse model. Besides neutrophils, NGAL is detectable in most tissues normally encountered by microorganisms, and its expression is upregulated in epithelial cells during inflammation. A growing number of studies have supported the clinical utility of NAGL for detecting invasive bacterial infections. Several investigators including our group have reported that measuring NGAL can be used to help predict and manage urinary tract infections and acute pyelonephritis. This article summarizes the biology and pathophysiology of NGAL and reviews studies on the implications of NGAL in various renal diseases from acute kidney injury to acute pyelonephritis.
Acute Kidney Injury ; Animals ; Bacterial Infections ; Biomarkers ; Biology ; Epithelial Cells ; Humans ; Immunity, Innate ; Inflammation ; Kidney Diseases* ; Kidney Transplantation ; Kidney* ; Lipocalins* ; Mice ; Neutrophils* ; Plasma ; Pyelonephritis ; Renal Insufficiency, Chronic ; Research Personnel ; Siderophores ; Urinary Tract Infections

Urinomas can occur after renal trauma or perforation of the collecting system during an endosurgical procedure. However, spontaneous urinomas are very rare. Here we report a case of a spontaneous perinephric urinoma following the removal of a Foley catheter in an 18-year-old girl with acute kidney injury caused by septic shock. The patient had been treated for septic shock, acute kidney injury, and acute respiratory distress syndrome, and had a Foley catheter in place for seven days. After Foley catheter removal, the patient complained of consistent voiding difficulty. An abdominal computed tomography scan showed a large amount of left perinephric fluid, and the aspirated fluid included urothelial cells, confirming the diagnosis of a urinoma. The urinoma was successfully treated by insertion of a double-J stent into the left ureter. This report discusses the available literature on urinomas, and their clinical features, diagnosis, and treatment.
Acute Kidney Injury* ; Adolescent ; Catheters* ; Diagnosis ; Female* ; Humans ; Respiratory Distress Syndrome, Adult ; Shock, Septic ; Stents ; Ureter ; Urinary Retention ; Urinoma* ; Vesico-Ureteral Reflux

PURPOSE: Urinary tract infection (UTI) caused by gram-positive uropathogens is usually hospital-acquired and associated with predisposing conditions. However, the incidence of gram-positive bacteria in community-acquired UTIs has recently increased worldwide. We aimed to investigate the clinical significance of UTI and associated genitourinary malformations in young children with febrile UTIs caused by gram-positive bacteria. METHODS: We retrospectively reviewed the medical records of 566 patients (age, <1 year) who visited the Korea University Medical Center for febrile UTIs between January 2008 and May 2013. We classified the patients into the following two groups: gram-positive (P group) and gram-negative (N group), according to the results of urine culture. The fever duration; white blood cell (WBC) counts and C-reactive protein (CRP) levels in peripheral blood; and the presence of hydronephrosis, cortical defects, vesicoureteral reflux (VUR), and renal scarring were compared between the two groups. RESULTS: The number of patients with gram-positive bacteria was 23 (4.1%) and with gram-negative bacteria was 543 (95.9%). The most common pathogen was Escherichia coli, and Enterococcus faecalis showed the highest incidence among gram-positive uropathogens. Patients with gram-positive bacteria showed longer fever duration compared to that in patients with gram-negative bacteria (P vs. N, 3.4+/-1.2 vs. 2.9+/-1.6 days, P<0.05). The incidence of VUR was increased in the gram-positive group compared to that in the gram-negative group (P vs. N, 55.6 vs. 17.8%, P<0.05). However, there were no significant differences in other laboratory and radiologic findings. CONCLUSION: The findings of our study show that community-acquired UTIs in patients younger than 1 year of age, caused by gram-positive uropathogens, can be associated with prolonged fever duration and the presence of VUR.
Academic Medical Centers ; C-Reactive Protein ; Child ; Cicatrix ; Enterococcus faecalis ; Escherichia coli ; Fever ; Gram-Negative Bacteria ; Gram-Positive Bacteria ; Humans ; Hydronephrosis ; Incidence* ; Korea ; Leukocytes ; Medical Records ; Retrospective Studies ; Urinary Tract Infections* ; Urinary Tract* ; Vesico-Ureteral Reflux

Neurofibromatosis type 1 (NF-1) is an autosomal dominant neurocutaneous disorder, which can affect different organs or systems of the body, including the cardiovascular system. One of the more serious aspects of the disease relates to arterial involvement. In particular, renal artery stenosis is one of the most common vascular abnormalities in patients with NF-1, and the manifestations vary, ranging from no symptoms to end-stage renal failure. Treatment usually consists of antihypertensive drugs, percutaneous transluminal angioplasty, or surgery. Other causes of hypertension should be ruled out and the patient followed up for close monitoring and proper management. We report a case of bilateral renal artery stenosis and hypertension in a patient with moyamoya disease associated with neurofibromatosis type 1. This report discusses the literature available on the current subject, its clinical features, diagnosis, and treatment.
Angioplasty ; Antihypertensive Agents ; Cardiovascular System ; Diagnosis ; Humans ; Hypertension* ; Kidney Failure, Chronic ; Moyamoya Disease* ; Neurocutaneous Syndromes ; Neurofibromatoses* ; Neurofibromatosis 1* ; Renal Artery Obstruction* ; Renal Artery*

Neurofibromatosis type 1 (NF-1) is an autosomal dominant neurocutaneous disorder, which can affect different organs or systems of the body, including the cardiovascular system. One of the more serious aspects of the disease relates to arterial involvement. In particular, renal artery stenosis is one of the most common vascular abnormalities in patients with NF-1, and the manifestations vary, ranging from no symptoms to end-stage renal failure. Treatment usually consists of antihypertensive drugs, percutaneous transluminal angioplasty, or surgery. Other causes of hypertension should be ruled out and the patient followed up for close monitoring and proper management. We report a case of bilateral renal artery stenosis and hypertension in a patient with moyamoya disease associated with neurofibromatosis type 1. This report discusses the literature available on the current subject, its clinical features, diagnosis, and treatment.
Angioplasty ; Antihypertensive Agents ; Cardiovascular System ; Diagnosis ; Humans ; Hypertension* ; Kidney Failure, Chronic ; Moyamoya Disease* ; Neurocutaneous Syndromes ; Neurofibromatoses* ; Neurofibromatosis 1* ; Renal Artery Obstruction* ; Renal Artery*

PURPOSE: We aimed to investigate the correlation between serum cystatin C and clinical manifestations in pediatric patients with urinary tract infections (UTIs). METHODS: We studied 137 patients admitted with UTIs from June 2012 to May 2014. Depending on the presence of renal cortical defects on 99m Tc-dimercaptosuccinic acid scintigraphy, we classified patients into non-renal and renal defect groups. Laboratory and clinical parameters were analyzed, including the levels of serum cystatin C. The correlation between cystatin C and other variables was assessed. RESULTS: Serum cystatin C levels did not differ between the non-renal and renal defect groups. In both groups, serum cystatin C levels increased after 4-5 days of treatment, compared with the level at admission (P<0.001). However, mean levels were within normal ranges. The concentration of serum cystatin C positively correlated with serum creatinine and negatively correlated with age (P<0.05). In contrast, there was no correlation between serum cystatin C and other variables. CONCLUSION: Serum cystatin C does not appear to be a useful biomarker for renal defects in pediatric patients with UTIs. Further studies are necessary to conclude whether serum cystatin C is helpful in predicting deterioration in renal function in pediatric patients with UTIs.
Child* ; Creatinine ; Cystatin C* ; Humans ; Pyelonephritis ; Radionuclide Imaging ; Reference Values ; Urinary Tract Infections*

Renal cortical necrosis (RCN) is patchy or diffuse ischemic destruction of the renal cortex caused by significantly reduced renal arterial perfusion. It is a rare cause of acute kidney injury (AKI) and is associated with high mortality. Here, we review the case of RCN in a 15-year-old boy who developed AKI. A 15-year-old boy was referred to our hospital from a local hospital due to a sharp decrease in his renal function. He presented with acute flank pain, nausea with vomiting, and oliguria for the past two days. He had taken a single dose of antihistamine for nasal congestion. At our hospital, his peak blood pressure was 148/83 mmHg and he had a high body mass index of 32.9 kg/m². The laboratory data showed a blood urea nitrogen (BUN) of 28.4 mg/dL, a creatinine of 4.26 mg/dL, and a glomerular filtration rate estimated from the serum cystatin C of 20.2 mL/min/1.73m². Proteinuria (spot urine protein to creatinine ratio 1.66) with pyuria was observed. Kidney sonography showed parenchymal swelling and increased renal echogenicity. Due to rapidly progressing nephritis, steroid pulse therapy (750 mg/IV) was done on the second day of his admission and the patient showed complete recovery with normal renal function. However, the kidney biopsy findings revealed renal cortical hemorrhagic necrosis. Multifocal, relatively well-circumscribed, hemorrhagic necrotic areas (about 25%) were detected in the tubulointerstitium. Although RCN is an unusual cause of AKI, especially in children, pediatricians should consider the possibility of RCN when evaluating patients with rapidly decreasing renal function.
Acute Kidney Injury ; Adolescent ; Biopsy ; Blood Pressure ; Blood Urea Nitrogen ; Body Mass Index ; Child ; Creatinine ; Cystatin C ; Estrogens, Conjugated (USP) ; Flank Pain ; Glomerular Filtration Rate ; Humans ; Kidney ; Kidney Cortex Necrosis ; Male ; Mortality ; Nausea ; Necrosis ; Nephritis ; Obesity ; Oliguria ; Perfusion ; Proteinuria ; Pyuria ; Vomiting

The ketogenic diet (KD) has been used as an effective antiepileptic therapy for intractable childhood epilepsy. However, various adverse effects have been reported with use of the KD. We report a case of a child who developed acute tubular necrosis subsequent to therapy with KD. A 5-year-old girl had myoclonic epilepsy with developmental delay. She was under the treatment with antiepileptic drugs since the age of 3 months and on the KD during the past 18 months. Proteinuria persisted intermittently with the initiation of the KD and subsequently increased in the past 2 months. She was admitted with intermittent mild fever, vomiting, and lethargy for the past 3–4 weeks. At the time of admission, she presented with hypertriglyceridemia, heavy proteinuria, renal Fanconi syndrome, and acute kidney injury. Renal sonography showed a marked increase in the size and parenchymal echogenicity of both kidneys. A renal biopsy revealed acute tubular necrosis accompanied by early interstitial fibrosis. After the withdrawal of the KD and supportive therapy, without changing other anticonvulsants and their dosages, improvement of renal function was observed. Proteinuria had disappeared after 1 month and kidney size returned to normal after 8 months. It is hypothesized that the KD can induce and/or aggravate the renal tubulointerstitial injury in some patients who are under the treatment with anticonvulsants.
Acute Kidney Injury ; Anticonvulsants ; Biopsy ; Child ; Child, Preschool ; Drug Resistant Epilepsy ; Epilepsies, Myoclonic ; Epilepsy ; Fanconi Syndrome ; Female ; Fever ; Fibrosis ; Humans ; Hypertriglyceridemia ; Ketogenic Diet ; Kidney ; Lethargy ; Necrosis ; Proteinuria ; Vomiting

BACKGROUND: Neutrophil gelatinase-associated lipocalin (NGAL), a bacteriostatic agent, is known to inhibit erythropoiesis leading to anemia. We aimed to investigate the associations of NGAL, anemia, and renal scarring in children with febrile urinary tract infections (UTIs).METHODS: We retrospectively reviewed the medical records of 261 children with febrile UTIs. The relationship between the presence of anemia and plasma NGAL levels was investigated. NGAL performance in comparison with serum C-reactive protein (CRP) at admission and after 72 hours of treatment was also evaluated for the prediction of renal scarring as well as acute pyelonephritis (APN) and vesicoureteral reflux (VUR).RESULTS: Plasma NGAL levels were elevated in patients with anemia compared with those without anemia. Multiple linear regression analysis showed an inverse relationship between NGAL levels and erythrocyte counts (standard β = −0.397, P < 0.001). Increased NGAL, but not CRP, was independently associated with the presence of anemia (odds ratio [OR], 2.37; 95% confidence interval [CI], 1.07–5.27; P < 0.05). Receiver operating curve analyses showed good diagnostic profiles of pre- and post-treatment NGAL for identifying APN, VUR, and renal scarring (all P < 0.05). For detecting renal scars, the area under the curve of post-treatment NGAL (0.730; 95% CI, 0.591–0.843) was higher than that of post-treatment CRP (0.520; 95% CI, 0.395–0.643; P < 0.05). The presence of anemia and elevated NGAL at admission (> 150 ng/mL) were independent risk factors for renal scarring in children with febrile UTIs. With anemia, NGAL levels increased consecutively in children with febrile UTI without renal involvement, with APN without scar, and with APN with renal scarring.CONCLUSION: Increased plasma NGAL levels may be associated with the presence of anemia and renal scarring in children with febrile UTIs.