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Metabolic acidosis is associated with infection severity in pediatric pyelonephritis and pneumonia

Hannah Brummer1,2, Hongyue Wang3, George J Schwartz4

  • 1Division of Nephrology, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. hbrummer@upa.chob.edu.

Pediatric Nephrology (Berlin, Germany)
|February 12, 2025
PubMed

Insights

Metabolic acidosis is common in pediatric pyelonephritis, occurring in 84% of cases. Lower bicarbonate levels correlate with longer hospital stays and more fever days in these patients.

Area of Science:

  • Pediatric Nephrology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Pyelonephritis is a frequent serious bacterial infection in children.
  • Metabolic acidosis is a known complication of pyelonephritis.
  • This study investigates the incidence and impact of metabolic acidosis in pediatric E. coli pyelonephritis.

Purpose of the Study:

  • To determine the frequency of metabolic acidosis in pediatric patients with acute E. coli pyelonephritis.
  • To compare the incidence and characteristics of metabolic acidosis in pyelonephritis versus pneumonia.
  • To assess the clinical significance of metabolic acidosis in relation to infection severity and outcomes.

Main Methods:

  • Retrospective, single-center study of pediatric patients hospitalized with pyelonephritis or pneumonia.
  • Collected nadir serum bicarbonate and anion gap values, along with baseline and recovery data when available.
  • Recorded serum electrolytes, creatinine, and markers of infection severity.

Main Results:

  • 84% of pyelonephritis patients developed acidosis compared to 66% of pneumonia patients.
  • Pyelonephritis patients had significantly lower mean nadir serum bicarbonate (20 mEq/L) and higher anion gap (16 mEq/L) than pneumonia patients.
  • Acidosis correlated with increased fever duration in pyelonephritis and longer hospital stay in both groups.

Conclusions:

  • Metabolic acidosis is highly prevalent in pediatric pyelonephritis.
  • Lower bicarbonate levels are associated with prolonged hospitalization and increased fever duration.
  • The findings highlight the clinical importance of monitoring and managing electrolyte balance in pediatric pyelonephritis.
Abstract

Keywords:
E. coliMetabolic acidosisPneumoniaPyelonephritis

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