Renal damage one year after first urinary tract infection: Role of dimercaptosuccinic acid scintigraphy

Stokland, Eira; Hellström, Mikael; Jacobsson, Bo; Jodal, Ulf; Sixt, Rune

doi:10.1016/s0022-3476(96)70024-0

Cited by 154 publications

(120 citation statements)

References 29 publications

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“…For this purpose, nephrologists generally take some specific clinical signs, such as high fever, serious enough to order a diagnostic imaging test. 15 Other known factors 7 that increase the likelihood of renal damage in children have been shown to be reflux, CRP and body temperature. Obviously, the probability of renal damage in children suffering from UTI and high levels of CRP, high fever and dilating reflux is up to ten times higher than their counterpart with normal or slightly elevated CRP levels, no or mild fever, and no reflux.…”

Section: Discussionmentioning

confidence: 99%

“…Eventually, they disappear over time. 6,7 Also, most of the pediatric nephrologists prefer to rely on clinical and biological findings in case of complicated UTI rather than scintigraphy. 8,9 However, it sometimes happens that clinical findings and equivocal urine cultures do not favor diagnosis, even though the patient may already have UTI and renal damage.…”

Section: Original Articlementioning

confidence: 99%

“…Only 16 (20%) children had neurogenic bladder. The median duration of fever was 3 days (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. Other paraclinical findings were as follows: CRP level of more than 6 mg/dL was reported in 61 (76.2%) children; leukocytosis in 42 (52.5%); and positive culture for Escherichia coli was obtained from 69 (86.2%) and the rest of the patients had other urinary microbial profiles.…”

Section: Clinical and Paraclinical Findingsmentioning

confidence: 99%

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Risk factors of renal scars in children with acute pyelonephritis

Ehsanipour¹,

Gharouni²,

Rafati³

et al. 2012

Braz J Infect Dis

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Section: Discussionmentioning

confidence: 99%

Section: Original Articlementioning

confidence: 99%

Section: Clinical and Paraclinical Findingsmentioning

confidence: 99%

See 1 more Smart Citation

Risk factors of renal scars in children with acute pyelonephritis

Ehsanipour¹,

Gharouni²,

Rafati³

et al. 2012

Braz J Infect Dis

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“…Long-term follow-up of children with renal scarring showed a significant reduction of renal function [20,32,33]. In contrast, children with a febrile urinary tract infection without lesion on acute-phase DMSA scintigraphy did not develop renal scarring [14,15,30].…”

Section: Introductionmentioning

confidence: 97%

“…Up to two thirds of children with acute pyelonephritis show a lesion (defect) on technetium99m-labelled dimercaptosuccinic acid (DMSA) scintigraphy during the acute phase [5,14,21,25]. Only these children develop post-infectious renal scarring and the incidence is 29-60% [5,15,21,24,30,35]. Long-term follow-up of children with renal scarring showed a significant reduction of renal function [20,32,33].…”

Section: Introductionmentioning

confidence: 99%

Randomised trial of oral versus sequential intravenous/oral cephalosporins in children with pyelonephritis

et al. 2007

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The hypothesis was tested that oral antibiotic treatment in children with acute pyelonephritis and scintigraphy-documented lesions is equally as efficacious as sequential intravenous/oral therapy with respect to the incidence of renal scarring. A randomised multi-centre trial was conducted in 365 children aged 6 months to 16 years with bacterial growth in cultures from urine collected by catheter. The children were assigned to receive either oral ceftibuten (9 mg/kg once daily) for 14 days or intravenous ceftriaxone (50 mg/kg once daily) for 3 days followed by oral ceftibuten for 11 days. Only patients with lesions detected on acute-phase dimercaptosuccinic acid (DMSA) scintigraphy underwent follow-up scintigraphy. Efficacy was evaluated by the rate of renal scarring after 6 months on follow-up scintigraphy. Of 219 children with lesions on acute-phase scintigraphy, 152 completed the study; 80 (72 females, median age 2.2 years) were given ceftibuten and 72 (62 females, median age 1.6 years) were given ceftriaxone/ Eur J Pediatr (2008) ceftibuten. Patients in the intravenous/oral group had significantly higher C-reactive protein (CRP) concentrations at baseline and larger lesion(s) on acute-phase scintigraphy. Follow-up scintigraphy showed renal scarring in 21/80 children treated with ceftibuten and 33/72 with ceftriaxone/ ceftibuten (p=0.01). However, after adjustment for the confounding variables (CRP and size of acute-phase lesion), no significant difference was observed for renal scarring between the two groups (p=0.2). Renal scarring correlated with the extent of the acute-phase lesion (r=0.60, p<0.0001) and the grade of vesico-ureteric reflux (r=0.31, p=0.03), and was more frequent in refluxing renal units (p=0.04). The majority of patients, i.e. 44 in the oral group and 47 in the intravenous/oral group, were managed as out-patients. Side effects were not observed. From this study, we can conclude that once-daily oral ceftibuten for 14 days yielded comparable results to sequential ceftriaxone/ceftibuten treatment in children aged 6 months to 16 years with DMSA-documented acute pyelonephritis and it allowed out-patient management in the majority of these children.

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Identification of Children and Adolescents at Risk for Renal Scarring After a First Urinary Tract Infection

Shaikh

Craig

Rovers³

et al. 2014

JAMA Pediatr

165

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IMPORTANCE No studies have systematically examined the accuracy of clinical, laboratory, and imaging variables in detecting renal scarring in children and adolescents with a first urinary tract infection. OBJECTIVES To identify independent prognostic factors for the development of renal scarring and to combine these factors in prediction models that could be useful in clinical practice. DATA SOURCES MEDLINE and EMBASE. STUDY SELECTION We included patients aged 0 to 18 years with a first urinary tract infection who underwent follow-up renal scanning with technetium Tc 99m succimer at least 5 months later. DATA EXTRACTION AND SYNTHESIS We pooled individual patient data from 9 cohort studies. MAIN OUTCOMES AND MEASURES We examined the association between predictor variables assessed at the time of the first urinary tract infection and the development of renal scarring. Renal scarring was defined by the presence of photopenia on the renal scan. We assessed the following 3 models: clinical (demographic information, fever, and etiologic organism) and ultrasonographic findings (model 1); model 1 plus serum levels of inflammatory markers (model 2); and model 2 plus voiding cystourethrogram findings (model 3). RESULTS Of the 1280 included participants, 199 (15.5%) had renal scarring. A temperature of at least 39°C, an etiologic organism other than Escherichia coli, an abnormal ultrasonographic finding, polymorphonuclear cell count of greater than 60%, C-reactive protein level of greater than 40 mg/L, and presence of vesicoureteral reflux were all associated with the development of renal scars (P Յ .01 for all). Although the presence of grade IV or V vesicoureteral reflux was the strongest predictor of renal scarring, this degree of reflux was present in only 4.1% of patients. The overall predictive ability of model 1 with 3 variables (temperature, ultrasonographic findings, and etiologic organism) was only 3% to 5% less than the predictive ability of models requiring a blood draw and/or a voiding cystourethrogram. Patients with a model 1 score of 2 or more (21.7% of the sample) represent a particularly high-risk group in whom the risk for renal scarring was 30.7%. At this cutoff, model 1 identified 44.9% of patients with eventual renal scarring. CONCLUSIONS AND RELEVANCE Children and adolescents with an abnormal renal ultrasonographic finding or with a combination of high fever (Ն39°C) and an etiologic organism other than E coli are at high risk for the development of renal scarring.

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Renal damage one year after first urinary tract infection: Role of dimercaptosuccinic acid scintigraphy

Cited by 154 publications

References 29 publications

Risk factors of renal scars in children with acute pyelonephritis

Risk factors of renal scars in children with acute pyelonephritis

Randomised trial of oral versus sequential intravenous/oral cephalosporins in children with pyelonephritis

Identification of Children and Adolescents at Risk for Renal Scarring After a First Urinary Tract Infection

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