Urinary infection, reflux and renal scarring in females continuously followed for 13?38 years

Martinell, Jeanette; Claësson, I.; Lidin-Janson, G; Jodal, Ulf

doi:10.1007/bf00860724

Cited by 103 publications

(68 citation statements)

References 19 publications

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“…These observations raise important questions. Are infants truly at a higher risk of renal scarring with APN compared with older children, as initially reported in the International Reflux Study (16) and subsequently endorsed by others (17,18). Recent studies have already questioned this conventional wisdom by reporting that younger age may not be a risk factor for renal scarring (19,20); the risk in older children may even be higher (21,22).…”

Section: Discussionmentioning

confidence: 96%

Renal Scarring in the Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) Trial

Mattoo¹,

Chesney²,

Greenfield³

et al. 2016

Clinical Journal of the American Society of Nephrology

100

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Background and objectives The main objectives of the Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) trial were to evaluate the role of antimicrobial prophylaxis in the prevention of recurrent urinary tract infection (UTI) and renal scarring in children with vesicoureteral reflux (VUR). We present a comprehensive evaluation of renal scarring outcomes in RIVUR trial participants.Design, setting, participants, & measurements This multicenter, randomized, placebo-controlled trial enrolled 607 children aged 2-71 months with grade 1-4 VUR diagnosed after a first or second febrile or symptomatic UTI. Study participants received trimethoprim-sulfamethoxazole or placebo and were followed for 2 years. Renal scarring was evaluated by baseline and follow-up 99m technetium dimercaptosuccinic acid (DMSA) renal scans that were reviewed independently by two blinded reference radiologists.Results At the end of the study, 58 (10%) of 599 children and 63 (5%) of 1197 renal units had renal scarring. New renal scarring did not differ between the prophylaxis and placebo groups (6% versus 7%, respectively). Children with renal scarring were significantly older (median age, 26 versus 11 months; P=0.01), had a second UTI before enrollment (odds ratio [OR], 2.85; 95% confidence interval [95% CI], 1.38 to 5.92), were more likely to be Hispanic (OR, 2.22; 95% CI, 1.13 to 4.34), and had higher grades of VUR (OR, 2.79; 95% CI, 1.56 to 5.0). The proportion of new scars in renal units with grade 4 VUR was significantly higher than in units with no VUR (OR, 24.2; 95% CI, 6.4 to 91.2).Conclusions Significantly more renal scarring was seen in relatively older children and in those with a second episode of febrile or symptomatic UTI before randomization. Preexisting and new renal scars occurred significantly more in renal units with grade 4 VUR than in those with low-grade or no VUR. Antimicrobial prophylaxis did not decrease the risk of renal scarring.

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Section: Discussionmentioning

confidence: 96%

Renal Scarring in the Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) Trial

Mattoo¹,

Chesney²,

Greenfield³

et al. 2016

Clinical Journal of the American Society of Nephrology

100

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“…2 This view had a considerable effect on recommendations for the initial treatment of UTI among febrile children. 3 However, according to a recent prospective study, the development of cortical scarring does not decrease with age (the study challenges the conventional view that the risk of renal scars after APN diminishes with age).…”

Section: Discussionmentioning

confidence: 99%

Treatment of Urinary Tract Infections Among Febrile Young Children With Daily Intravenous Antibiotic Therapy at a Day Treatment Center

et al. 2004

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ABSTRACT. Objective. Urinary tract infections (UTIs) are common among infants and toddlers. Children can be treated effectively with short courses (2-4 days) of intravenous (IV) therapy followed by oral therapy. If IV therapy is chosen, use of once-daily dosing may allow outpatient management instead of hospital admission. However, no description of ambulatory treatment with IV antibiotics of UTI among febrile children has been reported to date. We aimed to describe the feasibility and complications of outpatient management with IV antibiotics of UTI among febrile children, at the day treatment center (DTC) of a tertiary-care pediatric hospital.Methods. Between April 1, 2002, and March 31, 2003, a prospective cohort of patients 3 months to 5 years of age who were examined in the emergency department (ED) and diagnosed as having presumed febrile UTI were treated according to a clinical protocol. Patients were treated at the DTC unless they met exclusion criteria, in which case they were hospitalized. The DTC was open 7 days per week, including holidays, from 8:30 AM to 4:30 PM. At the DTC, patients were initially treated with a daily dose of IV gentamicin, until the child had been afebrile for at least 24 hours, and with oral amoxicillin, until preliminary urine culture results were available. Children allergic to penicillin received gentamicin only. IV antibiotics were administered through peripheral IV access; the IV catheter's patency was maintained with injection of 50 U of heparin once daily throughout the treatment period. Parental satisfaction with the DTC experience was assessed with an anonymous, self-administered questionnaire.Results. Two hundred ninety-one episodes of presumed febrile UTI were diagnosed in the ED, of which 212 (72.9%) were sent to the DTC. There were 71 hospital admissions (24.4%); in 9 of these instances, the child was admitted because parents refused or were unable to comply with DTC treatment. Adherence to the treatment protocol in the ED was excellent; in 92.1% of presumed febrile UTI episodes (268 of 291 episodes), the patient was referred to the appropriate setting for treatment. In 8 instances, patients who met an exclusion criterion were sent to the DTC. They should have been hospitalized, according to the protocol. At the DTC, a final diagnosis of UTI was made in 178 of the 212 episodes (84%). Patients treated at the DTC, with a final diagnosis of UTI, had a median age of 12.0 months (range: 3-68 months), and their mean initial temperature was 39.2°C (SD: 1.1°C). Patients were afebrile by 24 hours in 52% of UTI episodes and by 48 hours in 82%. Minor problems with IV access occurred in 9.0% of cases. The duration of IV antibiotic therapy at the DTC was 1.9 days (SD: 0.9 day). The mean number of visits to the DTC, including appointments for renal ultrasound and voiding cystourethrography evaluations, was 3.5 (SD: 0.9). Parents were present at all scheduled visits in 98.9% of cases. Four patients needed to be hospitalized from the DTC, but in only 1 case was hospital admission r...

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“…11,14,15,[22][23][24][25] No período de 2 a 38 anos, desaparecimento do refluxo ocorreu em 15% a 80% de crianças ou adolescentes. 9,14,16,22,[24][25][26][27][28] Em nossa casuística a porcentagem de pacientes e do número de ureteres que apresentaram resolução do RVU foi semelhante ao descrito na literatura. 15,16,[25][26][27][28] Em crianças menores de cinco anos no início do…”

Section: Discussionunclassified

Freqüência de desaparecimento do refluxo vésico-ureteral de graus I a III em pacientes pediátricos

Macedo¹,

Riyuzo²,

Bastos³

2004

Rev. Bras. Saude Mater. Infant.

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Objectives: to evaluate the frequency of disappearance of primary vesicoureteral reflux (VUR) grade I to III in children and correlate with patient's age at diagnosis, sex, grade and laterality.Methods: a retrospective study of 34 children with VUR detected by voiding cystourethrography (VCU). Five patients were boys (median of age: one year and six months) and 29 were girls (median of age: three years). Control exams by VCU or IC were made in performed 12 to 24 months. Kaplan-Meier survival curves were used for analysis.Results: VUR cessation was observed in 52.9% of patients. Comparing age it was not observed statistic difference. VUR cessation occurred in a median of 24 months in boys and 60 months in girls. There was statistic difference between sex (p = 0.02). VUR cessation occurred in 80% of patients with grade I (median: 25.5 months), 66.6% grade II (median: 48 months), 40% grade III (median: 60 months), in 21% of bilateral (median: 48 months) and 75% of unilateral VUR (median: 28.5 months). There was statistic difference between the grade (p = 0.02) and laterality (p = 0.05) of the VUR.Conclusions: VUR cessation occurred in grade I or II and unilateral, in boys, Key words Vesico ureteral reflux, EvoluçãoResumo Objetivos: avaliar a freqüência do desaparecimento do refluxo vésico-ureteral (RVU) primário de graus I a III em crianças e correlacionar com idade no diagnóstico, sexo, grau e lateralidade.Métodos: estudo retrospectivo de 34 crianças com RVU diagnosticado por uretrocistografia miccional (UCM). Cinco pacientes eram meninos (mediana: um ano e seis meses) e 29 meninas (mediana: três anos) O exame controle pela UCM ou cistografia foi realizado em intervalos de 12 a 24 meses. Na análise das variáveis utilizou-se a curva de sobrevida de KaplanMeier.Resultados: o desaparecimento do RVU ocorreu em 52,9% dos pacientes. Comparando faixas etárias não houve diferença estatística. Nos meninos o desaparecimento do RVU ocorreu na mediana de 24 meses e nas meninas, de 60 meses. Houve diferença estatís-tica entre os sexos (p = 0,02). Houve desaparecimento do RVU em 80% dos pacientes com RVU de grau I (mediana: 25,5 meses), 66,6% de grau II (mediana: 48 meses) 40% de grau III (mediana: 60 meses); em 21% no bilateral (mediana: 48 meses) e 75% no unilateral (mediana: 28,5 meses). Houve diferença estatística entre os graus de RVU (0,02) e lateralidade (p = 0,05).Conclusões: o desaparecimento do RVU ocorreu no sexo masculino, nos graus I ou II e unilateral. Refluxo vésico-ureteral, Evolução Palavras-chave

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Urinary infection, reflux and renal scarring in females continuously followed for 13?38 years

Cited by 103 publications

References 19 publications

Renal Scarring in the Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) Trial

Renal Scarring in the Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) Trial

Treatment of Urinary Tract Infections Among Febrile Young Children With Daily Intravenous Antibiotic Therapy at a Day Treatment Center

Freqüência de desaparecimento do refluxo vésico-ureteral de graus I a III em pacientes pediátricos

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