ABSTRACT
OBJECTIVES: To determine when pyelonephritic renal scarring was detected in children with urinary tract infection (UTI) and characterize those with primary and acquired scarring, respectively. STUDY DESIGN: A population-based cohort of 1221 children (989 girls and 232 boys) with first recognized symptomatic UTI, aged 0 to 15 years, were diagnosed and followed up prospectively at a single children's hospital; 652 had febrile UTI. Seven hundred fifty-three were evaluated by urography. Renal scarring was classified as primary or acquired, the latter without signs of scarring at the first investigation. To evaluate the frequency of recurrent UTI in those with acquired scarring, a comparison with group-matched children without scarring was performed. RESULTS: A total of 74 children without obstruction had renal scarring (acquired in 40). Primary scarring was found in 18 of 21 (86%) of the boys and 16 of 53 (30%) of the girls (P <.001). The majority of boys with scarring had dilated reflux (67%) in contrast to girls (23%). Recurrent UTI was rare in boys, whereas girls with acquired scarring had significantly more febrile recurrences than girls without scarring. CONCLUSIONS: Most boys had primary, probably congenital, reflux-associated renal damage, whereas most girls had acquired scarring related to recurrences of febrile UTI.
Subject(s)
Kidney Diseases/etiology , Urinary Tract Infections/complications , Adolescent , Case-Control Studies , Child , Child, Preschool , Cicatrix , Cohort Studies , Female , Fever/complications , Follow-Up Studies , Humans , Infant , Infant, Newborn , Kidney Diseases/congenital , Male , Population Surveillance , Prospective Studies , Pyelonephritis/complications , Recurrence , Urography , Vesico-Ureteral Reflux/complicationsABSTRACT
We analyzed the number of colony-forming units in urine cultures obtained by suprapubic aspiration in a group of 366 unselected infants with symptomatic urinary tract infection to relate these findings to factors such as pyuria and vesicoureteric reflux. Seventy-three (20%) of 366 infants had fewer than 100,000 colony-forming units per milliliter. Such low counts were significantly related to low numbers of leukocytes in the urine. Vesicoureteric reflux was equally distributed among children, irrespective of the number of bacteria in quantitative culture. The findings emphasize the importance of sampling technique; in infants, the method of choice is suprapubic aspiration, or catheterization, which eliminates the risk that urinary tract infection is overlooked because of low bacterial counts.