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
en 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.
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Pielonefritis
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Infecciones Urinarias
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Cicatriz
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Ácido Dimercaptosuccínico de Tecnecio Tc 99m
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Fiebre
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Riñón
Límite:
Child
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Child, preschool
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Female
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Humans
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Infant
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Male
Idioma:
En
Año:
2024
Tipo del documento:
Article