Risk of Renal Scarring in Children With a First Urinary Tract Infection: A Systematic Review

Shaikh, Nader; Ewing, Amy L.; Bhatnagar, Sonika; Hoberman, Alejandro

doi:10.1542/peds.2010-0685

Cited by 369 publications

(288 citation statements)

References 42 publications

Supporting

Mentioning

248

Contrasting

Unclassified

Order By: Relevance

“…Gram-negative infections probably increase tumor necrosis factor alpha production more than do gram-positive infections, and differences have also been found in plasma levels of interleukin (IL)-1, IL-6, IL-10 and IL-8 [1][2][3]. That gram-negative bacteremia induces a greater infl ammatory response than gram-positive bacteremia may help explain the higher PCT levels in gram-negative bacteremia ;this adequately explains why in the current study the highest PCT values were present in patients with Escherichia coli, Klebsiella spp.…”

Section: Discussionmentioning

confidence: 99%

“…Children who had an association between UTI and congenital structural abnormalities, such as vesicoureteral refl ux (VUR), are at higher risk for acute pyelonephritis (APN) and subsequent renal scarring (RS) [1,2]. Doubts have recently been raised about the long-term complications of VUR and infection-related renal damage [3], there is a belief that high -grade VUR predisposes to recurrent pyelonephritis and, may cause future serious morbidities, such as hypertension and/or impaired kidney function [4].…”

Section: Amongst Bacterial Infections Urinary Tract Infection (Uti)mentioning

confidence: 99%

See 1 more Smart Citation

Serum Procalcitonin Level is a Useful Predictor of Dilating Vesicoureteral Reflux in Patients with First Febrile Urinary Tract Infection

Shalaby¹,

Elsayed²

2017

Arch Clin Nephrol

View full text Add to dashboard Cite

Background: Procalcitonin (PCT) has been proposed as a novel biomarker for prediction of Vesicoureteral Refl ux (VUR). Since VUR is the most important risk factor for occurrence of pyelonephritis and renal tissue infl ammation, serum PCT level may have a relationship with VUR. However, literature about the relationship between procalcitonin level and VUR is scanty. Aim:We evaluated the predictive value of serum PCT level in the diagnosis of VUR in children admitted with their fi rst febrile UTI. Methods:We investigated 140 children with the fi rst febrile UTI (2m-10 yrs.). Serum PCT was measured before initiation of antibiotics. Standard voiding cystourethrography (VCUG) was performed in all children as the gold standard for detection of VUR. Sensitivity and specifi city of a high PCT level was evaluated using the receiver operating characteristic curve.Results: Seventy three patients(52%) had no VUR, while 67patients (48%) had VUR at least in one kidney, including grade 1 to 2 in 20 patients (14.3%) and , grade 3-5 in 47 (34.7%). PCT level ranged from 0.45 ng/ml to 12.7 ng/ml and, was signifi cantly higher with increasing the grading of VUR. Comparing procalcitonin levels with VCUG results, a sensitivity of 94% and a specifi city of 72% was obtained at a procalcitonin level of 0.52 ng/ml for diagnosis dilating VUR. There was a signifi cant correlation between PCT level and C-reactive protein. Conclusion:This study described that the PCT as an infl ammatory marker with proper sensitivity, specifi city, PPV and NPV seems likely benefi cial to predict dilating VUR.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Amongst Bacterial Infections Urinary Tract Infection (Uti)mentioning

confidence: 99%

Serum Procalcitonin Level is a Useful Predictor of Dilating Vesicoureteral Reflux in Patients with First Febrile Urinary Tract Infection

Shalaby¹,

Elsayed²

2017

Arch Clin Nephrol

View full text Add to dashboard Cite

show abstract

“…cases of febrile UTI and high-degree VUR. On the other hand, the incidence of renal scarring ranges from 15% to 62% (9)(10)(11)(12)(13) . In the present review, the authors' have not found in the Brazilian literature any study aimed at determining the prevalence of APN and incidence of renal scarring in the pediatric population.…”

Section: Discussionmentioning

confidence: 99%

“…Such characteristics have limited the associations of clinical/demographic variables with APN and renal scarring. The measurements of APN prevalence and renal scarring incidence could performed because of the utilization of a sample of satisfactory size, a method based on a systematic review study developed by Shaikh et al (10) . Finally, the present study results for APN and renal scarring frequencies are similar to those from other pediatric nephrology centers.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Prevalência de pielonefrite aguda e incidência de cicatriz renal em crianças menores de dois anos de idade com infecção do trato urinário avaliadas por cintilografia renal com 99mTc-DMSA: a experiência de um hospital universitário

et al. 2013

View full text Add to dashboard Cite

Tc-DMSA renal scintigraphy in a university hospital in Rio Grande do Sul between 2006 and 2009 were reviewed to investigate acute pyelonephritis/renal scarring. Additionally, the presence of vesicoureteral reflux, early use of antibiotics, and comorbidities were investigated on electronic records. The sample size calculation was based on a systematic review study and obtained a minimum of 147 patients. Patients whose electronic records were not available were excluded. Results: One hundred and fifty-seven children met the inclusion criteria; among them 48 had acute pyelonephritis and 8 of these had renal scars. Neither age nor sex presented any significant association with acute pyelonephritis (p = 0.405 and p = 0.124, respectively). No statistical significance was observed in the association between vesicoureteral reflux and acute pyelonephritis (p = 1.0) and other comorbidities (p = 0.470), and in relation to early use of antibiotics with acute pyelonephritis (p = 0.130) and renal scarring (p = 0.720). Conclusion: The frequencies found in the present study for acute pyelonephritis/renal scarring are in agreement with the results reported by most studies in the literature. Keywords: Pyelonephritis; DMSA; Scar.Objetivo: Calcular as frequências de pielonefrite aguda e cicatriz renal em pacientes menores de dois anos com cintilografia renal com 99m Tc-DMSA com primeiro quadro de infecção do trato urinário em hospital universitário brasileiro, comparando com dados da literatura internacional. Materiais e Métodos: Foram revisados laudos cintilográficos de crianças menores de dois anos de idade que realizaram cintilografia renal com 99m Tc-DMSA em um hospital universitário no Rio Grande do Sul, entre 2006 e 2009, para pesquisa de pielonefrite aguda/cicatriz renal. Revisaram-se a presença de refluxo vesicoureteral, o uso precoce de antibiótico, e a presença de comorbidades que constassem nos prontuários eletrônicos. Calculou-se a amostra com base num estudo de revisão sistemática e obteve-se um mínimo de 147 pacientes. Excluíram-se pacientes sem registro eletrônico. Resultados: Cento e cinquenta e sete crianças preencheram critérios de inclusão do estudo, 48 tiveram pielonefrite aguda e 8 destas apresentaram cicatriz renal. Nem a idade nem o gênero dos pacientes apresentaram associação significativa com pielonefrite aguda (p = 0,405 e p = 0,124, respectivamente). Não houve diferença estatística nas associações de refluxo vesicoureteral e pielonefrite aguda (p = 1,0) e outras comorbidades (p = 0,470) e em relação ao uso precoce de antibiótico com pielonefrite aguda (p = 0,130) e cicatriz renal (p = 0,720). Conclusão: As frequências de pielonefrite aguda e cicatriz renal obtidas concordam com os resultados da maioria dos estudos publicados. Unitermos: Pielonefrite; DMSA; Cicatriz. Berdichevski EH, Mattos SG, Bezerra S, Vilas ER, Baldisserotto M. Prevalence of acute pyelonephritis and incidence of renal scarring in children under the age of two with urinary tract infection evaluated by 99m Tc-DMSA renal scintigraphy: the...

show abstract

Long-term Follow-up of Patients After Childhood Urinary Tract Infection

Hannula¹,

Perhomaa²,

Venhola³

et al. 2012

Arch Pediatr Adolesc Med

View full text Add to dashboard Cite

To evaluate the long-term outcome of children with urinary tract infection (UTI). Design: Follow-up examination 6 to 17 years after childhood UTI. Setting: Secondary to tertiary referral center. Patients: From an original population-based cohort of 1185 children with a history of UTI on whom both ultrasonography (US) and voiding cystourethrography had been performed between January 1, 1993, and December 31, 2003, we excluded 24 cases with major renal dysplasia or obstruction of the urinary tract to form a study cohort of 1161 patients. We took a stratified random sample of 228 patients for follow-up, and a total of 193 (85%) participated. Of the 193 participating patients, 103 (53%) had received antibiotic prophylaxis and 42 (22%) had undergone surgery. Main Exposure: Urinary tract infection. Main Outcome Measures: Renal growth and parenchymal damage in US examination, kidney function, and blood pressure. Results: Unilateral renal parenchymal defect was found in 22 of the 150 patients (15%) studied with US at followup, and unilateral kidney growth retardation was found in 5 patients (3%). All but 1 of the renal parenchymal defects seen on US were in patients with grade III to V vesicoureteral reflux. Despite the parenchymal defects seen on US, the serum cystatin C concentration, estimated glomerular filtration rate, and blood pressure were within the normal ranges in all patients. Conclusions: The risk of long-term consequences from childhood UTI seems to be very low. Owing to the observational nature of our study, we cannot exclude the effects of the given treatment on the outcome of our patients.

show abstract

Risk of Renal Scarring in Children With a First Urinary Tract Infection: A Systematic Review

Abstract: The pooled prevalence values provided from this study provide a basis for an evidence-based approach to the management of children with this frequently occurring condition.

Cited by 369 publications

References 42 publications

Serum Procalcitonin Level is a Useful Predictor of Dilating Vesicoureteral Reflux in Patients with First Febrile Urinary Tract Infection

Serum Procalcitonin Level is a Useful Predictor of Dilating Vesicoureteral Reflux in Patients with First Febrile Urinary Tract Infection

Prevalência de pielonefrite aguda e incidência de cicatriz renal em crianças menores de dois anos de idade com infecção do trato urinário avaliadas por cintilografia renal com 99mTc-DMSA: a experiência de um hospital universitário

Long-term Follow-up of Patients After Childhood Urinary Tract Infection

Contact Info

Product

Resources

About