Document Detail

Risk of renal scarring in children with a first urinary tract infection: a systematic review.
MedLine Citation:
PMID:  21059720     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: To our knowledge, the risk of renal scarring in children with a urinary tract infection (UTI) has not been systematically studied.
OBJECTIVE: To review the prevalence of acute and chronic renal imaging abnormalities in children after an initial UTI.
METHODS: We searched Medline and Embase for English-, French-, and Spanish-language articles using the following terms: "Technetium (99m)Tc dimercaptosuccinic acid (DMSA)," "DMSA," "dimercaptosuccinic," "scintigra*," "pyelonephritis," and "urinary tract infection." We included articles if they reported data on the prevalence of abnormalities on acute-phase (≤15 days) or follow-up (>5 months) DMSA renal scans in children aged 0 to 18 years after an initial UTI. Two evaluators independently reviewed data from each article.
RESULTS: Of 1533 articles found by the search strategy, 325 full-text articles were reviewed; 33 studies met all inclusion criteria. Among children with an initial episode of UTI, 57% (95% confidence interval [CI]: 50-64) had changes consistent with acute pyelonephritis on the acute-phase DMSA renal scan and 15% (95% CI: 11-18) had evidence of renal scarring on the follow-up DMSA scan. Children with vesicoureteral reflux (VUR) were significantly more likely to develop pyelonephritis (relative risk [RR]: 1.5 [95% CI: 1.1-1.9]) and renal scarring (RR: 2.6 [95% CI: 1.7-3.9]) compared with children with no VUR. Children with VUR grades III or higher were more likely to develop scarring than children with lower grades of VUR (RR: 2.1 [95% CI: 1.4-3.2]).
CONCLUSIONS: The pooled prevalence values provided from this study provide a basis for an evidence-based approach to the management of children with this frequently occurring condition.
Nader Shaikh; Amy L Ewing; Sonika Bhatnagar; Alejandro Hoberman
Publication Detail:
Type:  Journal Article; Review     Date:  2010-11-08
Journal Detail:
Title:  Pediatrics     Volume:  126     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-12-02     Completed Date:  2011-02-08     Revised Date:  2012-08-02    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1084-91     Citation Subset:  AIM; IM    
Children's Hospital of Pittsburgh, Division of General Academic Pediatrics, 3414 Fifth Ave, Pittsburgh, PA 15213-2583, USA.
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MeSH Terms
Cicatrix / etiology*,  pathology
Kidney / pathology*
Kidney Diseases / etiology*,  pathology
Risk Factors
Urinary Tract Infections / complications*
Comment In:
J Pediatr. 2011 Jul;159(1):164   [PMID:  21669316 ]
J Urol. 2012 Jul;188(1):267   [PMID:  22682866 ]

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