An 8-year-old African American boy presents to the emergency department (ED) with a 1-day history of low back pain, generalized abdominal pain, and chills. While in the ED, the patient has multiple episodes of urinary incontinence, leaking small volumes of urine. The mother reports that the patient has been previously healthy and was asymptomatic before yesterday.

Physical examination reveals an ill-appearing child. Vital signs show a temperature of 101.2°F (38.4°C), heart rate of 125 beats/min, respiratory rate of 20 breaths/min, blood pressure of 128/80 mm Hg, and oxygen saturation of 99% on room air. He has diffuse abdominal tenderness without rebound or guarding. The remainder of the physical examination findings are normal.

In the ED, initial laboratory studies reveal a white blood cell (WBC) count of 17,900/μL (17.9×109/L) and a C-reactive protein (CRP) level of 140 mg/L (1,333 nmol/L). Lactic acid level and chemistry panel and urinalysis findings...

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