Persistent renal cortical scintigram defects in children 2 years after urinary tract infection

Ditchfield, Michael; Grimwood, Keith; Cook, David J.; Powell, Harley R.; Sloane, Robert; Gulati, Sanjeev; Campo, J. F. De

doi:10.1007/s00247-004-1182-z

Cited by 39 publications

(26 citation statements)

References 41 publications

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“…This opinion is supported by the report by Jodal et al identifying clear relationship between renal scarring and VUR and 66% of children with high grade VUR developed a renal scarring compared with 5% of children without VUR [12]. On the contrary, Ditchfield et al reported that although VUR may predispose patients to acute pyelonephritis, no association was established between the presence of VUR and persistent renal cortical defects [1]. Although we have not analyzed genetic susceptibility as the risk factor for ASL and USF several reports demonstrated the role of genetic susceptibilities as clinical determinants explain only a portion of individual risk [25].…”

Section: Discussionmentioning

confidence: 64%

The impact of therapeutic delay time on acute scintigraphic lesion and ultimate scar formation in children with first febrile UTI

Kim

Park

et al. 2011

Eur J Pediatr

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We assessed the role of therapeutic delay time (TDT) in acute renal cortical scintigraphic lesion (ASL) and ultimate scar formation (USF) in children with first febrile UTI and whether it is affected by the presence of vesico-ureteral reflux (VUR). 230 children, 90 girls and 140 boys with first febrile UTI were included. Radiologic (USG, DMSA, and VCUG), clinical (age, gender, peak fever, therapeutic delay time) and laboratory (CBC with differential count, ANC (absolute neutrophil count), BUN, Creatinine, urine analysis, gram stain, culture, CRP and ESR) variables were analysed. DMSA was performed within 5 days and after six months. VCUG was performed after acute phase of UTI. The differences in TDT according to the presence of ASL, USF and VUR were assessed. And the correlation between ASL or USF with the duration of TDT was assessed. Of 230 patients enrolled, 142 patients had refluxing UTI and 88 patients had non-refluxing UTI. TDT was the risk factor associated with ASL and USF along with presence of VUR. TDT was longer in ASL positive group compared with the ASL negative group. Also USF group showed longer TDT compared with those without USF in both refluxing UTI and non refluxing UTI. The TDT was significantly shorter in USF group with the presence of VUR. Positive linear association was noted between prevalence of ASL and USF and duration of TDT. In conclusion, the impact of UTI on formation of USF may be enhanced by the presence of VUR with shorter duration of TDT.

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Section: Discussionmentioning

confidence: 64%

The impact of therapeutic delay time on acute scintigraphic lesion and ultimate scar formation in children with first febrile UTI

Kim

Park

et al. 2011

Eur J Pediatr

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“…A further difficulty of the scintigraphy studies (including the present research) is to make the distinction between acquired renal scarring and congenital dysplasia in patients with persistent photon defect on DMSA scintigraphy [9]. Without exact patient history or previous imaging, the aetiology of scars cannot always be determined.…”

Section: Discussionmentioning

confidence: 89%

Randomised trial of oral versus sequential intravenous/oral cephalosporins in children with pyelonephritis

et al. 2007

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The hypothesis was tested that oral antibiotic treatment in children with acute pyelonephritis and scintigraphy-documented lesions is equally as efficacious as sequential intravenous/oral therapy with respect to the incidence of renal scarring. A randomised multi-centre trial was conducted in 365 children aged 6 months to 16 years with bacterial growth in cultures from urine collected by catheter. The children were assigned to receive either oral ceftibuten (9 mg/kg once daily) for 14 days or intravenous ceftriaxone (50 mg/kg once daily) for 3 days followed by oral ceftibuten for 11 days. Only patients with lesions detected on acute-phase dimercaptosuccinic acid (DMSA) scintigraphy underwent follow-up scintigraphy. Efficacy was evaluated by the rate of renal scarring after 6 months on follow-up scintigraphy. Of 219 children with lesions on acute-phase scintigraphy, 152 completed the study; 80 (72 females, median age 2.2 years) were given ceftibuten and 72 (62 females, median age 1.6 years) were given ceftriaxone/ Eur J Pediatr (2008) ceftibuten. Patients in the intravenous/oral group had significantly higher C-reactive protein (CRP) concentrations at baseline and larger lesion(s) on acute-phase scintigraphy. Follow-up scintigraphy showed renal scarring in 21/80 children treated with ceftibuten and 33/72 with ceftriaxone/ ceftibuten (p=0.01). However, after adjustment for the confounding variables (CRP and size of acute-phase lesion), no significant difference was observed for renal scarring between the two groups (p=0.2). Renal scarring correlated with the extent of the acute-phase lesion (r=0.60, p<0.0001) and the grade of vesico-ureteric reflux (r=0.31, p=0.03), and was more frequent in refluxing renal units (p=0.04). The majority of patients, i.e. 44 in the oral group and 47 in the intravenous/oral group, were managed as out-patients. Side effects were not observed. From this study, we can conclude that once-daily oral ceftibuten for 14 days yielded comparable results to sequential ceftriaxone/ceftibuten treatment in children aged 6 months to 16 years with DMSA-documented acute pyelonephritis and it allowed out-patient management in the majority of these children.

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“…However, female gender may be possibly associated with LUTD but not with renal scarring. In fact, Ditchfield et al [14] analyzed renal scarring in 196 children following they first UTI and after stratifying renal scarring by age, they reported no association between renal scarring and gender.…”

Section: Discussionmentioning

confidence: 99%

“…Children with shrunken kidney or renal atrophy and diffuse scarring had been discharged and did not take part in this study. This was to exclude the possibility of bias due to congenital renal damage rather than postnatally acquired damage [13][14][15][16].…”

Section: Methodsmentioning

confidence: 99%

Risk factors for renal scarring in children and adolescents with lower urinary tract dysfunction

et al. 2007

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Risk factors for renal scarring in children with lower urinary tract dysfunction (LUTD) were evaluated. The medical records of 120 patients were assessed concerning gender, presence of vesicoureteric reflux (VUR), bladder capacity, detrusor overactivity, residual urine, febrile urinary tract infection (UTI), bacteriuria, constipation, detrusor sphincter incoordination (DSI), high detrusor pressure at maximal cystometric capacity (PMCC), low compliance, and thickness and trabeculation of the bladder wall. Renal scarring was diagnosed by (99m)technetium-dimercaptosuccinic acid renal scan (DMSA). Renal scarring was detected in 38 patients (31%). VUR, UTI, decreased bladder capacity, urinary residue, and trabeculated and thick bladder wall were associated with scarring at univariate analysis. Multivariate analysis showed VUR (P < 0.0001) as the independent risk factor for renal scarring. Thickness of the bladder wall was a marginal risk factor (P = 0.07). Although UTI was not a risk factor, it was associated with VUR (P = 0.03). In our analysis, VUR was the main risk factor; however, renal scarring was probably due to multifactorial causes, as VUR was associated with UTI.

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Persistent renal cortical scintigram defects in children 2 years after urinary tract infection

Cited by 39 publications

References 41 publications

The impact of therapeutic delay time on acute scintigraphic lesion and ultimate scar formation in children with first febrile UTI

The impact of therapeutic delay time on acute scintigraphic lesion and ultimate scar formation in children with first febrile UTI

Randomised trial of oral versus sequential intravenous/oral cephalosporins in children with pyelonephritis

Risk factors for renal scarring in children and adolescents with lower urinary tract dysfunction

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