First episode of febrile urinary tract infection in children, detection and risk factors of kidney scarring: A prospective cohort study.
Clin Nephrol
; 102: 16-24, 2024 Jul.
Article
in En
| MEDLINE
| ID: mdl-38726574
ABSTRACT
AIMS:
This prospective study aimed to evaluate the characteristics and findings of children who presented with acute pyelonephritis (APN) and to determine the independent risk factors for kidney scarring. MATERIAL ANDMETHODS:
Patients who satisfied the following criteria were enrolled in the study first known episode of APN; at least two of the followingfindings:
fever ≥ 38.5 °C, white blood cell count ≥ 10,000/mm3, erythrocyte sedimentation rate ≥ 20 mm/h, C-reactive protein ≥ 20 mg/dL; absence of congenital abnormalities or other kidney and systemic diseases, except vesicoureteral reflux (VUR); no APN relapses until the time of kidney scar detection. 99mTc-Dimercaptosuccinic acid kidney scintigraphy (99mTc-DMSA) was performed at admission, along with a kidney ultrasound. Follow-up 99mTc-DMSA took place after 6 months. Radiographic cystourethrography for VUR detection and grading was performed 1 month after the acute infection.RESULTS:
We enrolled 70 children in the study. The kidney ultrasound failed to diagnose more than half of the cases of APN. VUR was found in 21.5% of children. 75% had findings of APN in the acute phase through 99mTc-DMSA, while in the second 99mTc-DMSA, there was a complete remission in 68% of them. Scars were observed more frequently in older children, children with VUR grade ≥ III, and children not on antibiotic prophylaxis.CONCLUSION:
VUR did not appear to be associated with the first episode of APN, and children older than 1 year of age had a higher risk of scarring. Antibiotic prophylaxis may prevent kidney scarring due to host immunomodulatory effects, but more studies are needed so that conclusions can be drawn.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Pyelonephritis
/
Urinary Tract Infections
/
Cicatrix
/
Technetium Tc 99m Dimercaptosuccinic Acid
/
Fever
/
Kidney
Limits:
Child
/
Child, preschool
/
Female
/
Humans
/
Infant
/
Male
Language:
En
Journal:
Clin Nephrol
Year:
2024
Document type:
Article