Renal dysfunction in recurrent urinary tract infections in childhood

Berg, Ulla

doi:10.1007/bf00859616

Cited by 16 publications

(3 citation statements)

References 17 publications

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“…It has been shown that children who have had one episode of pyelonephritis show a lower glomerular filtration rate than healthy controls, which is in agreement with this study, and the glomerular filtration rate was lower in children with renal scars and recurrent pyelonephritis episodes. 26 27 In these studies renal scars were detected by intravenous urography and therefore they may have been larger than the scars detected in this study by a DMSA scan.…”

Section: Resultsmentioning

confidence: 47%

Renal scarring after acute pyelonephritis.

Jakobsson

Berg

Svensson

1994

Archives of Disease in Childhood

270

117

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Seventy six children, 18 boys and 58 girls, aged 0-15 9 (median 1.0) years, with acute pyelonephritis were prospectively studied with a technetium-99m dimercaptosuccinic acid (DMSA) scan during infection and two months later. Fifty nine of these children were also studied two years after the infection. Seventeen Previous studies have shown that renal scarring was almost always associated with vesicoureteric reflux (VUR).9 Later studies using the DMSA scan, however, have suggested that scarring may often occur in the absence of VUR,5 and it has been claimed that renal scarring may be independent of the presence or absence of VUR.10 We therefore need to reassess our knowledge in this field on the basis of studies in which acute pyelonephritis has been diagnosed and followed up with DMSA scans.The aim of this prospective clinical study was to determine the incidence of renal scarring after acute pyelonephritis and how this correlated with previously well known risk factors such as VUR, age, delay in starting treatment, and recurrent urinary tract infections. Patients and methodsSeventy six patients (152 kidneys), 18 boys and 58 girls, aged 0-15-9 (median 1 0) years, consecutively admitted to our hospital with the clinical diagnosis of acute pyelonephritis were studied with a DMSA scan within five days of admission and about two months later. Figure 1 gives the age and sex distributions of the children. Acute pyelonephritis was defined as fever :38 5°C, C reactive protein >20 mg/l, or erythrocyte sedimentation rate >20 mm/hour, and a positive urinary culture. The laboratory data during acute pyelonephritis in most of these children have been published previously.5 All the children were available for long term follow up and a DMSA scan was performed in 59 (78%) of them after two years. The remaining 17 (22%) children had a normal DMSA scan at two months and 11 (65%) of these also had a normal DMSA scan during infection. After the initial treatment, all children received prophylactic antibiotics until the second investigation at two months, and none had a breakthrough infection during that time.

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Section: Resultsmentioning

confidence: 47%

Renal scarring after acute pyelonephritis.

Jakobsson

Berg

Svensson

1994

Archives of Disease in Childhood

270

117

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“…Except in children below 3 months of age, in whom the quality of the scintigrams is not always ideal, Jakobsson et al [11,12] consider that a normal DMSA scintigram practically excludes the diagnosis of upper urinary tract infection. Studying inulin and para-aminohippuric acid clearance in children with recurrent pyelonephritis, Berg [13,14] showed that the clearance rate was related to the grade of morphological impairment; when both kidneys were normal, the clearance values were still slightly lower than in the normal control group. However, the normality of the kidneys was estimated on the basis of intravenous urography which, even in the opinion of the author [11], is less sensitive than DMSA scintigraphy.…”

Section: Discussionmentioning

confidence: 99%

Estimation of normal chromium-51 ethylene diamine tetra-acetic acid clearance in children

Piepsz

Pintelon²,

Ham

1994

Eur J Nucl Med

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In order to estimate the normal range of chromium-51 ethylene diamine tetra-acetic acid (EDTA) clearance in children, we selected a series of 256 patients with past or present urinary tract infection who showed, at the time of the clearance determination, normal technetium-99m dimercaptosuccinic acid (DMSA) scintigraphy and normal left to right DMSA relative uptake. The clearance was calculated by means of either the simplified second exponential method or the 120-min single blood sample; Chantler's correction was used in order to correct for having neglected the first exponential. There was a progressive increase in clearance from the first weeks of life (mean value around 1 month: 55 ml/min/1.73 m2), with a plateau at around 18 months. Between 2 and 17 years of age, the clearance values remained constant, with a mean value of 114 ml/min/1.73 m2 (SD: 24 ml/min); this is similar to the level described for inulin clearance. No significant differences were observed between boys and girls, or between clearance values calculated with one or with two blood samples. Taking into account the hour of intravenous injection of the tracer, we did not observe any influence of the lunchtime meal on the distribution of the 51Cr-EDTA clearance values.

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“…GFR was generally reduced in patients with early onset PN and a history of several PN infections. Thus, the authors believed long-term prophylactic antibacterial therapy was indicated in patients with early onset PN, in order to prevent recurrences [28]. The high vulnerability of infant kidneys may partially be due to the fact that recognition and treatment of pyelonephritis is often delayed within the first years of life.…”

Section: Current Clinical Indications For Antibacterial Prophylaxismentioning

confidence: 99%

May we go on with antibacterial prophylaxis for urinary tract infections?

Beetz¹

2005

Pediatr Nephrol

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Recurrent urinary tract infections (UTIs), with or without vesicoureteric reflux (VUR), are by far the most frequent reason for long-term antibacterial prophylaxis in infants and children today. However, the strategies of antibacterial prophylaxis for the prevention of recurrent urinary tract infection are no longer universally accepted. In infants and children at risk, the benefits of antibacterial prophylaxis definitively are not yet proven by evident data. To put antibacterial prophylaxis in its place, risk groups for recurrent symptomatic infections, ascending UTI and permanent renal damage have to be defined and the efficacy of prophylaxis in these groups has to be proved by prospective randomised studies. Nevertheless, until the results of these studies are available, antibacterial prophylaxis will remain one of the most frequently practised methods to protect risk patients from pyelonephritic damage and UTI recurrences.

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Renal dysfunction in recurrent urinary tract infections in childhood

Cited by 16 publications

References 17 publications

Renal scarring after acute pyelonephritis.

Renal scarring after acute pyelonephritis.

Estimation of normal chromium-51 ethylene diamine tetra-acetic acid clearance in children

May we go on with antibacterial prophylaxis for urinary tract infections?

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