The typical case of acute pyelonephritis with fever, flank pain and tenderness, dysuria and often concomitant pyuria, seldom presents difficulty in diagnosis. The atypical acute case, presenting only with fever, without pyuria or symptoms relating to the urinary tract, and the recurrent, chronic, or incompletely treated urinary tract infections are, on the other hand, frequent diagnostic problems. These silent insidious infections may ultimately produce permanent renal impairment, uremia, and death. The problem is one of early diagnosis of the unrecognized infections and of adequate therapy and follow-up once this diagnosis is made.
The importance of pyuria as a diagnostic sign of urinary tract infection has been exaggerated in the past. Although its presence is of clinical significance, its absence in patients with bacteriuria is well documented.1-4 The urine culture emerges as the only dependable method of determining the presence of urinary-tract infection, but the culture itself must include a
HINKLE NH, PARTIN JC, WEST CD, Partin JS. Diagnosis of Acute and Chronic Pyelonephritis in Children: Use of a Simple Spread Plate Technique for Colony Counting. Am J Dis Child. 1960;100(3):335–340. doi:10.1001/archpedi.1960.04020040335005
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