Clinical Pyelonephritis and Focal Renal Scarring: A Selected Review of Pathogenesis, Prevention, and Prognosis

Winberg, Jan; Bollgren, I; Källenius, Gunilla; Möllby, R.; Svenson, Stefan B.

doi:10.1016/s0031-3955(16)34213-4

Cited by 197 publications

(91 citation statements)

References 37 publications

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“…Therapeutic delay has been associated with an increased frequency of renal scarring in experimental'9 and clinical reports.15 20 In this study, most of the children were referred within the first three or four days of fever and none after more than seven days. Our results therefore suggest that there is no difference in the frequency of renal scarring if treatment is started within the first week of infection.…”

Section: Resultsmentioning

confidence: 72%

Renal scarring after acute pyelonephritis

Jakobsson¹,

Berg²,

Svensson³

1994

Pediatr Nephrol

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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: 72%

Renal scarring after acute pyelonephritis

Jakobsson¹,

Berg²,

Svensson³

1994

Pediatr Nephrol

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“…Some risk factors making children with a UTI more vulnerable to renal damage include young age at the time of infection (Winberg et al 1982), delayed treatment (Miller and Phillips 1981;Winberg et al 1982), the presence of vesicoureteral reflux (VUR) (Biggi et al 2001;Chroustova et al 2006;Faust et al 2009), and although mentioned infrequently, the extent of kidney lesions (Biggi et al 2001). ALN is a severe disease entity, with extensive renal parenchymal involvement (Cheng et al 2009).…”

Section: A High Incidence Of Renal Scarring Is Associated With Child mentioning

confidence: 99%

Studies on Clinical Characteristics, Urovirulence Factor and Host Susceptibility Gene in Pediatric Acute Lobar Nephronia

Cheng¹,

Tsau²,

Lin³

2011

Urinary Tract Infections

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“…88,89 Similarly, there may be a relationship between young age (Յ3 years) at first episode of pyelonephritis and decreased glomerular filtration rate. 90 However, the relationship between renal scar formation and renal function is not well defined, and the long-term clinical significance of renal scars remains to be demonstrated.…”

Section: Circumcision Status and Uti In Infant Malesmentioning

confidence: 99%

Circumcision Policy Statement

Lannon¹,

Bailey²,

Fleischman³

et al. 1999

Pediatrics

339

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ABSTRACT. Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In circumstances in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. If a decision for circumcision is made, procedural analgesia should be provided.ABBREVIATIONS. UTI, urinary tract infection; STD, sexually transmitted disease; NCHS, National Center for Health Statistics; DPNB, dorsal penile nerve block; SCCP, squamous cell carcinoma of the penis; HPV, human papilloma virus; HIV, human immunodeficiency virus.A lthough 1 the exact frequency is unknown, it is estimated that 1.2 million newborn males are circumcised in the United States annually at a cost of between $150 and $270 million. This practice has been advocated for reasons that vary from symbolic ritual to preventive health measure. Until the last half century, there has been limited scientific evidence to support or repudiate the routine practice of male circumcision.Over the past several decades, the American Academy of Pediatrics has published several policy statements on neonatal circumcision of the male infant. [1][2][3] Beginning in its 1971 manual, Standards and Recommendations of Hospital Care of Newborn Infants, and reiterated in the 1975 and 1983 revisions, the Academy concluded that there was no absolute medical indication for routine circumcision.In 1989, because of new research on circumcision status and urinary tract infection (UTI) and sexually transmitted disease (STD)/acquired immunodeficiency syndrome, the Academy concluded that newborn male circumcision has potential medical benefits and advantages as well as disadvantages and risks.4 This statement also recommended that when circumcision is considered, the benefits and risks should be explained to the parents and informed consent obtained. Subsequently, a number of medical societies in the developed world have published statements that do not recommend routine circumcision of male newborns. [5][6][7] In its position statement, the Australian College of Paediatrics emphasized that in all cases, the medical attendant should avoid exaggeration of either risks or benefits of this procedure. 5Because of the ongoing debate, as well as the publication of new research, it was appropriate to reevaluate the issue of routine neonatal circumcision. This Task Force adopted an evidence-based approach to analyzing the medical literature concerning circumcision. The studies reviewed were obtained through a search of the English language medical literature from 1960 to the present and, additionally, through a search of the bibliographies of the published studies. EPIDEMIOLOGYThe percentage of male infants circumcised va...

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Clinical Pyelonephritis and Focal Renal Scarring: A Selected Review of Pathogenesis, Prevention, and Prognosis

Cited by 197 publications

References 37 publications

Renal scarring after acute pyelonephritis

Renal scarring after acute pyelonephritis

Studies on Clinical Characteristics, Urovirulence Factor and Host Susceptibility Gene in Pediatric Acute Lobar Nephronia

Circumcision Policy Statement

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