Renal scarring after acute pyelonephritis.

Abstract

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.

Cicatriz renal detectada mediante cintigrama renal DMSA en niños con primera pielonefritis aguda: estudio de factores de riesgo

“…Múltiples factores de riesgo como menor edad, alto grado de RVU, virulencia del microorganismo causante y retraso en el inicio del tratamiento antibiótico, han sido correlacionados con el desarrollo de cicatriz renal, sin embargo, la patogéne-sis de ella es aún muy controvertida 4,[12][13][14] .…”

“…Múltiples factores se han intentado asociar a la generación de cicatriz renal posterior a la pielonefritis aguda: virulencia del germen, retraso en el inicio del tratamiento antibiótico, edad del paciente, presencia de reflujo vésico ureteral (RVU), etc. Sin embargo, existe controversia sobre el rol de cada uno de ellos y el rol potencial de otros factores [4][5][6][7] .…”

The effect of vitamin A on renal damage following acute pyelonephritis in children

“…Antibiotic therapy with ceftriaxone continued for 10 days and followed by administration of prophylactic treatment with cephalexin syrup (15 mg/kg). A second renal DMSA scan was performed for each patient 3 months after hospital discharge, and the degree of damage and the occurrence of scar were compared with those of the first renal DMSA scan [7,12]. It is worth mentioning that between the first and the second renal DMSA scans, all patients were requested to have monthly U/A and U/C for detection of recurrent UTI although none was found to suffer any recurrent urinary tract infection.…”

“…These complications are mainly produced following the formation of renal scarring in patients with UTI. Renal scarring is significantly correlated with presence of gross vesicoureteral reflux and recurrent pyelonephritis [12]. According to several studies, vitamin A deficiency causes an increase in urinary infections incidence while the administration of vitamin A leads to reduction in UTI incidence [2,4,6,15].…”

The effects of methylene blue on renal scarring due to pyelonephritis in rats

“…These results suggest that the addition of MB to the delayed antibiotic therapy might be beneficial in preventing PNP-induced oxidative renal tissue damage. Pyelonephritis (PNP) is common in children and adults; about one third of all children [1] and nearly half of all adults [2] develop renal scarring after infection. Acute PNP causes considerable morbidity and accounts for significant health care costs [2].…”