Suppurative Pyelonephritis in a Newborn with Congenital Urinary Tract Malformation: Diagnostic Challenges and Management Approach: a Case Report

Abstract

Purulent kidney lesions occupy a special place in pediatric practice, yet only isolated or small series of cases have been reported to date. This paper presents a clinical case of a 12-day-old patient admitted with lethargy, feeding refusal, fever, and depressed consciousness. Epidemiological history revealed prolonged household contact with varicella. Examination revealed enlargement of the right kidney with multiple diffuse focal changes in the parenchyma, enlargement of the left kidney, multiple microabscesses, signs of ureterohydronephrosis, and bladder wall thickening. Surgical revision of the right kidney was performed via a translumbar approach, with placement of a subcapsular drain and insertion of a cystostomy. The patient received antibacterial, antiviral, and infusion therapy, along with immunological support. Discharge from hospital occurred on day 32 of admission. At follow-up, at the age of 5 months, the Foley cystostomy catheter was removed, and a universal 5Ch ureteral stent was placed in the left ureter, which was removed at 6 months. This clinical case of suppurative pyelonephritis in a newborn with a congenital urinary tract malformation demonstrates the need for staged treatment and formation of a multidisciplinary team of specialists — neonatologists, pediatric surgeons, pediatric urologists, nephrologists, and clinical pharmacologists — for timely diagnosis and successful management.

Keywords

newborn / suppurative pyelonephritis / congenital urinary tract malformation / diagnosis / treatment

References

[1] Pieretti RV, Pieretti-Vanmarcke R, Pieretti A. Renal abscess in previously healthy girl. Urology. 2009;73(2):297–298. doi: 10.1016/j.urology.2008.07.044

[2] Bakradze MD, Zorkin SN, Zelikovich EI, et al. Complicated forms of pyelonephritis in children. Pediatric pharmacology. 2013;10(2):92–99. doi: 10.15690/pf.v10i2.650 EDN: PZSUKV

[3] Chung VY, Tai CK, Fan CW, Tang CN. Severe acute pyelonephritis: a review of clinical outcome and risk factors for mortality. Hong Kong Med J. 2014;20(4):285–289. doi: 10.12809/hkmj134061

[4] Morozov SL, Dlin BB. Pyelonephritis in children. Modern view of the problem. Pediatrician’s practice. 2020;(1):32–39. (In Russ.) EDN: KBHCLC

[5] Kuzovleva GI, Grushitskaya EV, Staroverov OV, et al. Comparative evaluation of the results of conservative and surgical methods of treatment of children with destructive forms of pyelonephritis. Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(3):339–350. doi: 10.17816/psaic975 EDN: QIGHVO

[6] Buschel H, Leung P, Stalewski H, et al. Renal abscesses in children: an 11-year retrospective study and review of the literature. ANZ J Surg. 2022;92(12):3293–3297. doi: 10.1111/ans.17943

[7] Zhang X, Xie Y, Huang G, Fu H. Analysis of 17 children with renal abscess. Int J Clin Exp Pathol. 2019;12(9):3179–3184.

[8] Alsowayan OS. A rare case of pyonephrosis in an infant induced by extended-spectrum beta-lactamase-producing Klebsiella pneumoniae. Saudi J Med Med Sci. 2020;8(2):156–159. doi: 10.4103/sjmms.sjmms_91_18

[9] Charlier C, Anselem O, Caseris M, et al. Prevention and management of VZV infection during pregnancy and the perinatal period. Infect Dis Now. 2024;54(4):104857. doi: 10.1016/j.idnow.2024.104857

RIGHTS & PERMISSIONS

Eco-Vector