Presentation
Fevers, chills, nausea, general myalgia, and lethargy on the background of recurrent ineffectively treated urinary tract infections and type two diabetes mellitus.
Patient Data
An ovoid region of hypo-enhancement within the lower pole of the right kidney measures approximately 36 mm in the long axis. No definite capsule formation. Small regions of patchy hypo-enhancement are demonstrated anteriorly and posteriorly within the right kidney. Moderate adjacent perinephric stranding. Minimal fat stranding adjacent to the right proximal ureter.
Case Discussion
Lobar nephronia, also known as acute focal bacterial nephritis, is considered to represent the progression of acute pyelonephritis that has not evolved into an intrarenal abscess 1-3.
The distinction between nephronia and an intrarenal abscess is of clinical significance in determining disposition and guiding treatment. Nephronia is treated similarly to acute pyelonephritis with intravenous antibiotics and may require infectious disease consultation to guide antibiotic therapy. On the other hand, intrarenal abscess formation may require surgical intervention via drainage. Urology consultation is recommended and interval surveillance is paramount in identifying whether the nephronia has evolved into an intrarenal abscess 1-3.
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