[Acute pyelonephritis--clinical picture and the main diagnostic and therapeutic problems in children].

The aim of the study was to determine the main clinical and organising difficulties affecting quality and efficacy of medical care in children with acute pyelonephritis (AP). 41 children aged 3 wk--17 yr 4 mo hospitalized for AP at the Department of Nephrology, District Children's Hospital, Szczecin, Poland in 2000 were investigated. Epidemiologic and demographic data, history, clinical presentation, auxiliary investigations, treatment and ambulatory follow-up were analysed. Instead of typical clinical picture neither diagnostic management nor the therapy fulfilled accepted standards. The main problems found were: delay of referral to hospital by primary care doctor, misdiagnosis or inaccurate primary diagnosis followed by insufficient treatment, difficulties with performing simple ambulatory tests (urinalysis, urine culture, ultrasonography) before hospitalisation and lack of co-operation between parents and nephrological outpatient clinic after discharge. For reflux and obstructive nephropathy, often presenting as urinary tract infection, are still the main cause of chronic renal failure in children in Poland the special attention was paid to necessity of thorough education of family doctors in the subject of management of such cases as well as improvement of accessibility to specialistic care.