An atypical case of a 2-year-old boy with acute kidney injury: a race against time. Questions

Excerpt

We report the case of a 2-year-old Caucasian Belgian boy who was transferred to the pediatric intensive care unit of our hospital with persistent fever and acute kidney injury. At the time of his initial visit to the general practitioner he presented with high fever, respiratory symptoms (coughing, rhinitis), vomiting, abdominal pain and cervical lymphadenopathy; he was prescribed oral amoxicillin and ibuprofen for a suspected upper respiratory tract infection. However, 3 days later he had to be admitted to the local hospital due to persistent fever. Bacterial sepsis was suspected, and his antibiotic treatment was switched to intravenous amoxicillin–clavulanate, but without improvement. He had no history of any major illnesses or kidney disease and had no previous history of medication use. His condition worsened, and high spiking fever (temperatures ≥104 °F) persisted, but repeated cultures (blood, urine) remained negative. Elevated serum creatinine and blood urea nitrogen (BUN) levels were also noted, and he developed metabolic acidosis for which sodium bicarbonate was given. These symptoms led to a suspicion of a tubulointerstitial nephritis secondary to sepsis. …