Acute pyelonephritis and sequelae of renal scar in pediatric first febrile urinary tract infection

Lin, Kuang Yen; Chiu, Nan-Tsing; Chen, Mei Ju; Lai, Ching Horng; Huang, Jing; Wang, Yu Tai; Chiou, Yuan-Yow

doi:10.1007/s00467-003-1109-1

Cited by 123 publications

(50 citation statements)

References 25 publications

(19 reference statements)

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“…Adult pig kidneys scar as quickly as those of piglets with VUR and UTI 25 and scarring is known to occur in adult mature kidneys transplanted into pediatric patients 26 . Some recent studies have reported that the age may not be a risk factor for renal scarring and the risk in older children is the same 21, 27, 28 or even higher 29, 30 as compared to the younger children.…”

Section: Risk Factors For Rnmentioning

confidence: 99%

Vesicoureteral Reflux and Reflux Nephropathy

Mattoo

2011

Advances in Chronic Kidney Disease

122

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Primary vesicoureteral reflux (VUR) is the commonest congenital urological abnormalities in children, which has been associated with an increased risk of urinary tract infection (UTI) and renal scarring, also called reflux nephropathy (RN). In children, RN is diagnosed mostly after UTI (acquired RN) or during follow-up for antenatally diagnosed hydronephrosis with no prior UTI (congenital RN). The acquired RN is more common in female children whereas the congenital RN is more common in male children. This observation in children might help explain the differences in the clinical presentation of RN in adults, with males presenting mostly with hypertension, proteinuria, and progressive renal failure as compared to females who present mostly with recurrent UTI and have a better outcome. Known risk factors for RN include the severity of VUR, recurrent UTI, and bladder-bowel dysfunction; younger age and delay in treatment are believed to be other risk factors. Management of VUR is controversial and includes antimicrobial prophylaxis, surgical intervention, or surveillance only. No evidence-based guidelines exist for appropriate follow-up or the management of patients with RN.

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Section: Risk Factors For Rnmentioning

confidence: 99%

Vesicoureteral Reflux and Reflux Nephropathy

Mattoo

2011

Advances in Chronic Kidney Disease

122

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“…Upper UTIs in young children can cause permanent kidney damage. An estimated 57% of children with acute pyelonephritis develop renal scarring [5]. UTIs are classically treated with trimethoprim/sulfamethoxazole or ciprofloxacin to eradicate the infecting strain.…”

Section: Introductionmentioning

confidence: 99%

Mucosal Immunization with Iron Receptor Antigens Protects against Urinary Tract Infection

et al. 2009

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Uncomplicated infections of the urinary tract, caused by uropathogenic Escherichia coli, are among the most common diseases requiring medical intervention. A preventive vaccine to reduce the morbidity and fiscal burden these infections have upon the healthcare system would be beneficial. Here, we describe the results of a large-scale selection process that incorporates bioinformatic, genomic, transcriptomic, and proteomic screens to identify six vaccine candidates from the 5379 predicted proteins encoded by uropathogenic E. coli strain CFT073. The vaccine candidates, ChuA, Hma, Iha, IreA, IroN, and IutA, all belong to a functional class of molecules that is involved in iron acquisition, a process critical for pathogenesis in all microbes. Intranasal immunization of CBA/J mice with these outer membrane iron receptors elicited a systemic and mucosal immune response that included the production of antigen-specific IgM, IgG, and IgA antibodies. The cellular response to vaccination was characterized by the induction and secretion of IFN-γ and IL-17. Of the six potential vaccine candidates, IreA, Hma, and IutA provided significant protection from experimental infection. In immunized animals, class-switching from IgM to IgG and production of antigen-specific IgA in the urine represent immunological correlates of protection from E. coli bladder colonization. These findings are an important first step toward the development of a subunit vaccine to prevent urinary tract infections and demonstrate how targeting an entire class of molecules that are collectively required for pathogenesis may represent a fundamental strategy to combat infections.

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“…DMSA scintigraphy is considered the most sensitive test for the diagnosis of renal involvement and the subsequent development of renal scarring [1, 2]. The renal cortical changes are acceptably detected by Tc-99m-DMSA renal scintigraphy.…”

Section: Discussionmentioning

confidence: 99%

“…Technetium-99m-dimercaptosuccinic acid (DMSA) renal scintigraphy is considered the most sensitive test for the diagnosis of renal involvement and the subsequent development of renal scarring [1, 2]. …”

Section: Introductionmentioning

confidence: 99%

Could Pyelonephritic Scarring Be Prevented by Anti-Inflammatory Treatment? An Experimental Model of Acute Pyelonephritis

Özdoğan

Özdemir

İmamoğlu

et al. 2014

BioMed Research International

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Objectives. This study aimed to demonstrate if the addition of anti-inflammatory treatment to antibiotic therapy shows any superiority to the treatment with antibiotic only. Methods. Forty-nine Wistar rats were divided into 7 groups. Pyelonephritis was performed by E. coli injection to upper pole of kidneys except control group. Group 2 was not treated. Ceftriaxone, ketoprofen, “ceftriaxone + ketoprofen,” methylprednisolone, and “ceftriaxone + methylprednisolone” were given in the groups. The technetium-99m-dimercaptosuccinic acid scintigraphies were performed in 3rd day to detect pyelonephritis and 10th week to detect renal scarring. All kidneys were also histopathologically evaluated. Results. When 3rd day and 10th week scintigraphies were compared, initial 2.00 ± 0.30 point pyelonephritis score resulted in 0.71 ± 0.36 renal scar score in “ceftriaxone + ketoprofen” group (P = 0.039). Initial 2.00 ± 0.43 point pyelonephritis score resulted in 0.86 ± 0.26 renal scar score in “ceftriaxone + methylprednisolone” group (P = 0.041). Renal scar score was declined in “ceftriaxone + ketoprofen” group and “ceftriaxone + methylprednisolone” group compared with no-treatment group on 10th week of the study (P = 0.026, P = 0.044). On histopathological evaluation, it was seen that renal scar prevalence and expansion declined significantly in “ceftriaxone + ketoprofen and ceftriaxone + methylprednisolone” (P = 0.011, P = 0.023). Conclusion. It was evidenced that ceftriaxone treatment in combination with ketoprofen or methylprednisolone declined scar formation in scintigraphic and histopathologic examinations of the kidneys.

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Acute pyelonephritis and sequelae of renal scar in pediatric first febrile urinary tract infection

Cited by 123 publications

References 25 publications

Vesicoureteral Reflux and Reflux Nephropathy

Vesicoureteral Reflux and Reflux Nephropathy

Mucosal Immunization with Iron Receptor Antigens Protects against Urinary Tract Infection

Could Pyelonephritic Scarring Be Prevented by Anti-Inflammatory Treatment? An Experimental Model of Acute Pyelonephritis

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