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Peer-reviewedCC BY 4.0Frontiers in Medicine

Acute kidney injury in an elderly patient with presumed acute focal bacterial nephritis: a case report highlighting diagnostic challenges

  • Qi Li1
  • Daorina Bao1
  • Haidong Zhang1
  • Zhuan Cui1
  • Yao Yao2
  • Min Lu2
  • Danxia Zheng1
  • Yue Wang1
  1. 1Department of Nephrology, Peking University Third Hospital, Beijing, China
  2. 2Department of Pathology, Peking University Third Hospital, Beijing, China
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Abstract

Acute focal bacterial nephritis (AFBN) is often characterized as a complicated form of upper urinary tract infection. Its relationship with acute kidney injury (AKI) is not well established, and most reported cases have preserved renal function because most patients respond well to antibiotic treatment. We report a 74-year-old woman with type 2 diabetes mellitus who presented with fever, diarrhea, oliguria, and severe AKI requiring hemodialysis. Blood and urine next-generation sequencing identified Escherichia coli. Imaging showed bilateral renal enlargement and cortical swelling suggestive of presumed AFBN. Despite 4 weeks of antibiotic therapy, renal function failed to recover. Empirical corticosteroid therapy transiently increased urine output but did not improve serum creatinine. Renal biopsy revealed IgA-dominant infection-related glomerulonephritis (IgA-IRGN) with tubulointerstitial injury. She remained dialysis-dependent 1 year later. This case illustrates the complexity of AKI in a patient with sepsis, presumed AFBN, and IgA-IRGN. We highlight the importance of considering multiple etiologies and the role of renal biopsy when renal function fails to recover after infection control.

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Cite

BibTeXRIS
BibTeX
@article{li2026acute,
  title = {{Acute kidney injury in an elderly patient with presumed acute focal bacterial nephritis: a case report highlighting diagnostic challenges}},
  author = {Qi Li and Daorina Bao and Haidong Zhang and Zhuan Cui and Yao Yao and Min Lu and Danxia Zheng and Yue Wang},
  journal = {Frontiers in Medicine},
  year = {2026},
  month = oct,
  doi = {10.3389/fmed.2026.1948946},
  url = {https://doi.org/10.3389/fmed.2026.1948946},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Acute kidney injury in an elderly patient with presumed acute focal bacterial nephritis: a case report highlighting diagnostic challenges
AU  - Qi Li
AU  - Daorina Bao
AU  - Haidong Zhang
AU  - Zhuan Cui
AU  - Yao Yao
AU  - Min Lu
AU  - Danxia Zheng
AU  - Yue Wang
PY  - 2026
DA  - 2026/10/22
JO  - Frontiers in Medicine
DO  - 10.3389/fmed.2026.1948946
UR  - https://doi.org/10.3389/fmed.2026.1948946
AB  - Acute focal bacterial nephritis (AFBN) is often characterized as a complicated form of upper urinary tract infection. Its relationship with acute kidney injury (AKI) is not well established, and most reported cases have preserved renal function because most patients respond well to antibiotic treatment. We report a 74-year-old woman with type 2 diabetes mellitus who presented with fever, diarrhea, oliguria, and severe AKI requiring hemodialysis. Blood and urine next-generation sequencing identified Escherichia coli. Imaging showed bilateral renal enlargement and cortical swelling suggestive of presumed AFBN. Despite 4 weeks of antibiotic therapy, renal function failed to recover. Empirical corticosteroid therapy transiently increased urine output but did not improve serum creatinine. Renal biopsy revealed IgA-dominant infection-related glomerulonephritis (IgA-IRGN) with tubulointerstitial injury. She remained dialysis-dependent 1 year later. This case illustrates the complexity of AKI in a patient with sepsis, presumed AFBN, and IgA-IRGN. We highlight the importance of considering multiple etiologies and the role of renal biopsy when renal function fails to recover after infection control.
SN  - 2296-858X
ER  -