Early treatment of urinary infection prevents renal damage on cortical scintigraphy

Hiraoka, Masahiro; Hashimoto, Gotaro; Tsuchida, Shinya; Tsukahara, Hirokazu; Ohshima, Yusei; Mayumi, Mitsufumi

doi:10.1007/s00467-002-1023-y

Cited by 48 publications

(19 citation statements)

References 24 publications

(33 reference statements)

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“…It is believed that prompt antibiotic treatment of UTI diminishes the risk of renal scarring [12, 34]. However, two recent studies, by Hewitt et al [35] and Doganis et al [36], demonstrated that early treatment (< 1 day of fever) of acute pyelonephritis in infants and young children had no significant effect on the incidence of subsequent renal scarring when compared with children treated after 24 h. However, Doganis et al showed that early and appropriate treatment, especially during the first 24 h after symptom onset, may diminish the likelihood of renal involvement during the acute phase of the infection [36].…”

Section: Uti Treatmentmentioning

confidence: 99%

Managing urinary tract infections

Saadeh

Mattoo

2011

Pediatr Nephrol

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Urinary tract infections (UTI) are common in childhood. Presence of pyuria and bacteriuria in an appropriately collected urine sample are diagnostic of UTI. The risk of UTI is increased with an underlying urological abnormality such as vesicoureteral reflux, constipation, and voiding dysfunction. Patients with acute pyelonephritis are at risk of renal scarring and subsequent complications such as hypertension, proteinuria with and without FSGS, pregnancy-related complications and even end-stage renal failure. The relevance and the sequence of the renal imaging following initial UTI, and the role of antimicrobial prophylaxis and surgical intervention are currently undergoing an intense debate. Prompt treatment of UTI and appropriate follow-up of those at increased risk of recurrence and/or renal scarring are important.

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Section: Uti Treatmentmentioning

confidence: 99%

Managing urinary tract infections

Saadeh

Mattoo

2011

Pediatr Nephrol

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“…The importance of the duration of fever before treatment initiation (FBT) has been previously studied with controversial results 2 5 7–15. However, it is generally accepted that delaying treatment for over 48 or 72 hours can lead to acute renal lesions and consequent permanent renal lesions based on DMSA scintigraphy findings 9 10 13 15…”

Section: Introductionmentioning

confidence: 99%

Fever duration during treated urinary tract infections and development of permanent renal lesions

et al. 2018

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ObjectiveTo assess the effect of the duration of fever after the initiation of treatment (FAT) of febrile urinary tract infections (UTI) on the development of permanent renal lesions based on dimercaptosuccinic acid (DMSA) scintigraphy findings. To evaluate the FAT contribution to permanent renal lesion formation in relation to fever before treatment initiation (FBT), the presence of vesicourinary reflux (VUR), age and severity of infection.MethodsThe inpatient records of 148 children (median age: 2.4 months (11 days to 24 months)) with a first episode of UTI during a 3-year period were analysed. DMSA findings, and clinical and laboratory parameters were evaluated.ResultsAmong the study population, 34/148 (22.97%) children had permanent renal lesions on the DMSA scan 6 months after a single episode of UTI. Twenty-three children (15.5%) had mild, 10 (6.7%) had moderate and 1 (0.6%) child had severe lesions on the DMSA. FAT prolongation >/48 hours was associated with older age (p=0.01) and increased absolute neutrophil count (p=0.042). The likelihood of lesions was significantly increased when FAT was ≥48 hours (R2=0.043, p=0.021). On multiple regression analysis, with the addition of FBT>/72 hours (0.022), the presence of VUR (p<0.001), C-reactive protein (p=0.027) and age (p=0.031), the effect of FAT on lesion development disappeared (p=0.15).ConclusionsProlongation of FAT≥48 hours of febrile UTI in children <2 years significantly contributes to the development of permanent renal lesions. However, delay in treatment initiation >/72 hours, the presence of VUR, older age and infection severity seem to be more significant predictors of the development of renal lesions.

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“…Renal scarring develops in 10-40% of children with repeated febrile UTI (fUTI) (4). Risk factors for renal scarring in children after repeated fUTI involve age at presentation, sex, race, peak fever, treatment delay, and the presence of vesicoureteral reflux (VUR) (3,5,6). Children with renal scarring may develop chronic kidney disease in later life, and this eventually leads to end-stage renal disease (ESRD) (3,7).…”

mentioning

confidence: 99%

Urinary C-megalin for screening of renal scarring in children after febrile urinary tract infection

et al. 2017

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BackgroundFebrile urinary tract infection (fUTI) in children may cause renal scarring. This study aimed to investigate the usefulness of urinary biomarkers for diagnosing renal scarring after fUTI.MethodsThirty-seven children (median age: 1.36 years, range: 0.52-12.17 years, 25 boys) with a history of fUTI, who underwent renal scintigraphy for 4 months or longer after the last episode of fUTI, were analyzed. A spot urine sample was obtained on the day of renal scintigraphy to measure levels of total protein, N-acetyl-β-D-glucosaminidase (NAG), β-microglobulin (BMG), neutrophil gelatinase-associated lipocalin (NGAL), liver-type fatty acid binding protein (L-FABP), and C-megalin (full-length megalin). Results were corrected for urinary creatinine (Cr) and compared between the group with renal scarring (n=23) and that without scarring (n=14). Urinary levels of C-megalin were also measured in healthy control subjects.ResultsNo significant differences in total protein, NGAL, L-FABP, NAG, and BMG levels were found between the groups. However, C-megalin levels were significantly higher in the renal scarring group than in the non-renal scarring group and healthy controls (P<0.001). A cutoff value of 6.5 pmol/nmol of urinary C-megalin/Cr yielded 73.9% of specificity and 92.9% of sensitivity.ConclusionUrinary C-megalin is useful for diagnosing renal scarring caused by fUTI.

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Early treatment of urinary infection prevents renal damage on cortical scintigraphy

Cited by 48 publications

References 24 publications

Managing urinary tract infections

Managing urinary tract infections

Fever duration during treated urinary tract infections and development of permanent renal lesions

Urinary C-megalin for screening of renal scarring in children after febrile urinary tract infection

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