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Pediatrics. 2010 Dec;126(6):1084-91. doi: 10.1542/peds.2010-0685. Epub 2010 Nov 8.

Risk of renal scarring in children with a first urinary tract infection: a systematic review.

Author information

1
Children's Hospital of Pittsburgh, Division of General Academic Pediatrics, 3414 Fifth Ave, Pittsburgh, PA 15213-2583, USA. nader.shaikh@chp.edu

Abstract

BACKGROUND:

To our knowledge, the risk of renal scarring in children with a urinary tract infection (UTI) has not been systematically studied.

OBJECTIVE:

To review the prevalence of acute and chronic renal imaging abnormalities in children after an initial UTI.

METHODS:

We searched Medline and Embase for English-, French-, and Spanish-language articles using the following terms: "Technetium (99m)Tc dimercaptosuccinic acid (DMSA)," "DMSA," "dimercaptosuccinic," "scintigra*," "pyelonephritis," and "urinary tract infection." We included articles if they reported data on the prevalence of abnormalities on acute-phase (≤15 days) or follow-up (>5 months) DMSA renal scans in children aged 0 to 18 years after an initial UTI. Two evaluators independently reviewed data from each article.

RESULTS:

Of 1533 articles found by the search strategy, 325 full-text articles were reviewed; 33 studies met all inclusion criteria. Among children with an initial episode of UTI, 57% (95% confidence interval [CI]: 50-64) had changes consistent with acute pyelonephritis on the acute-phase DMSA renal scan and 15% (95% CI: 11-18) had evidence of renal scarring on the follow-up DMSA scan. Children with vesicoureteral reflux (VUR) were significantly more likely to develop pyelonephritis (relative risk [RR]: 1.5 [95% CI: 1.1-1.9]) and renal scarring (RR: 2.6 [95% CI: 1.7-3.9]) compared with children with no VUR. Children with VUR grades III or higher were more likely to develop scarring than children with lower grades of VUR (RR: 2.1 [95% CI: 1.4-3.2]).

CONCLUSIONS:

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.

PMID:
21059720
DOI:
10.1542/peds.2010-0685
[Indexed for MEDLINE]

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