Girls prone to urinary infections followed into adulthood. Indices of renal disease

Martinell, Jeanette; Lidin-Janson, G; Jagenburg, Rudolf; Sivertsson, Ramon; Claësson, I.; Jodal, Ulf

doi:10.1007/s004670050082

Cited by 13 publications

(23 citation statements)

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“…A study of women with scarring using DMSA confirmed that renal function was reasonably well preserved and that the incidence of hypertension was lower than had previously been reported. 27 …”

Section: Discussionmentioning

confidence: 99%

Role of Various Imaging Modalities After a First Febrile Urinary Tract Infection in Young Children

Kawoosa¹,

Ali²,

Kubran³

2018

jemds

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BACKGROUND UTI in the paediatric population is well-recognised as the cause of acute morbidity and chronic medical conditions such as hypertension and renal insufficiency in adulthood. 1 The goal of imaging studies in children with UTI is to identify anatomic abnormalities that predispose to infection, determine whether there is active renal involvement and to assess whether renal function is normal or at risk. Aims and Objectives- To measure the incidence of renal scarring in patients admitted with first febrile UTI.  To list renal image findings in patients with first febrile UTI, 1 -36 months of age. MATERIALS AND METHODSA total of 108 patients, 1 -36 months of age, coming with first febrile UTI, either admitted or on an outpatient department basis during one and a half years, who satisfy the inclusion criteria were studied. Renal scanning with technetium-99m labeled dimercaptosuccinic acid and renal ultrasonography were performed in the acute phase to determine the presence or absence of acute pyelonephritis and anatomical abnormalities, respectively. Contrast voiding cystourethrography was performed approximately one month after diagnosis in those with abnormal ultrasound or abnormal DMSA. Technetium-99m labeled dimercaptosuccinic acid renal scanning was repeated six months later to determine the incidence and severity of renal scarring. Age groups, sex, VCUG, renal ultrasonography and DMSA renal scintigraphy results were analysed. RESULTSOut of 108 patients, RBUS was normal in 63 (58%) and abnormal in 45 (42%). Sonogram showed changes consistent with acute pyelonephritis in 27.7% (30/108) of the whole group and in only 57.7% (30/52) of the patients with scintigraphically documented acute pyelonephritis. DMSA was suggestive of acute pyelonephritis in 52 (48%) patients in acute stage and of renal scarring in 22 (20%) at 6 months. All patients who had scarring at 6 months had abnormal initial scan. Out of 69 patients with abnormal ultrasonography or scanning who were subjected to VCUG, 39 had vesicoureteral reflux (56.5%). Renal scarring was more likely to occur in children with documented VUR than those without VUR (17/39 vs. 5/30). Among the patients with VUR, scarring was seen more likely in patients with higher grades of VUR. CONCLUSIONThe renal ultrasound is of limited value in febrile UTI, especially at places where DMSA scanning is available. The use of DMSA during acute illness identifies patients with acute pyelonephritis who are at risk of development of renal scarring later in life. VCUG may demonstrate a relationship between VUR and renal inflammation and identify high-risk group for development of renal scarring. KEYWORDSUrinary Tract Infection, VUR, DMSA Scan. HOW TO CITE THIS ARTICLE: Kawoosa KM, Ali SW, Kubran SH. Role of various imaging modalities after a first febrile urinary tract infection in young children. J. Evolution Med. Dent. Sci. 2018;7(11):1404-1408, DOI: 10.14260/jemds/2018/319 BACKGROUND UTI in the paediatric population is well-recognised as a cause of acute morbidity ...

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Section: Discussionmentioning

confidence: 99%

Role of Various Imaging Modalities After a First Febrile Urinary Tract Infection in Young Children

Kawoosa¹,

Ali²,

Kubran³

2018

jemds

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“…115 Removal of a scarred kidney when the contralateral kidney is thought to be normal does not, however, always cure hypertension. 63 Moreover, differential renal vein renin activity measurements in hypertensive patients with unilateral scarring may not localise the increased renin release to the scarred kidney and attention must therefore be paid to the PRA in the renal vein of the radiologically normal kidney.…”

Section: Managementmentioning

confidence: 99%

Reflux nephropathy and hypertension

Goonasekera

Dillon

1998

J Hum Hypertens

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Renal scarring associated with vesico-ureteric reflux (VUR), most commonly detected in young children, is associated with a significant risk of developing hypertension in later life. Hypertension in reflux nephropathy contributes significantly to morbidity including deterioration of renal function. The mechanism of onset of hypertension is not clear although abnormalities of the renin-angiotensin system and sodium/potassium ATPase activity have been described in some cases. It is becoming clear that radiologically detectable renal scars or small kidneys may histologically indicate a variety of diagnoses. Prediction of the risk of developing hypertension in individual cases is difficult and there-

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“…It has been shown that adults with persistent reflux and scarring may run the risk of further pyelonephritis, progressive renal disease and hypertension [Martinell et al 1996[Martinell et al , 1995, and VUR is likely a major factor in the pathogenesis of recurrent UTI, acute pyelonephritis and renal scarring [Faust et al 2009]. Thus, the aims of treatment are to reduce the risk of febrile UTIs affecting the upper urinary tract and, possibly, protect against future renal damage.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic treatment of vesicoureteral reflux: current practice and the need for multifactorial assessment

Läckgren

Stenberg

2009

Therapeutic Advances in Urology

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Vesicoureteral reflux (VUR) affects around 1% of all children. It carries an increased risk of febrile urinary-tract infections (UTIs) and is associated with impaired renal function. Antibiotic prophylaxis is an established approach to managing the condition, but it does not protect against UTI and encourages bacterial resistance. Ureteral re-implantation (open surgery) is a relatively traumatic procedure typically requiring hospitalization, and there is a risk of significant post-treatment complications. Endoscopic treatment with NASHA/Dx gel (Deflux Õ ) is minimally invasive, well tolerated and provides cure rates approaching those of open surgery: 8090% in several studies. It has also been shown to be effective in a variety of 'complicated' cases. Thus, endoscopic treatment is generally preferable to open surgery and long-term antibiotic prophylaxis. Non-treatment of VUR is being discussed as an alternative option, although this mainly appears suitable for children with low-grade reflux and normal kidneys. A new approach to managing VUR may be considered, with treatment decisions based not only on the grade of reflux but also on factors such as age, sex, renal scarring and bladder dysfunction. Open surgery would be reserved only for use in the 1015% of children not responding to endoscopic treatment and those with severe ureteral anomalies.

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Girls prone to urinary infections followed into adulthood. Indices of renal disease

Cited by 13 publications

References 0 publications

Role of Various Imaging Modalities After a First Febrile Urinary Tract Infection in Young Children

Role of Various Imaging Modalities After a First Febrile Urinary Tract Infection in Young Children

Reflux nephropathy and hypertension

Endoscopic treatment of vesicoureteral reflux: current practice and the need for multifactorial assessment

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