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Published on: July 18, 2017
Early treatment of urinary infection prevents renal damage on cortical scintigraphy
Masahiro Hiraoka1, Gotaro Hashimoto, Shinya Tsuchida
1Department of Pediatrics, Fukui Medical University School of Medicine, Matsuoka, Fukui 910-1193 Japan. hiraoka@fmsrsa.fukui-med.ac.jp
Insights
Early treatment of febrile urinary infections in children within 24 hours can prevent kidney damage. Delayed treatment, especially after 24 hours, significantly increases the risk of renal changes and necessitates prompt intervention.
Area of Science:
- Pediatric Nephrology
- Pediatric Infectious Diseases
- Nuclear Medicine
Background:
- Delayed diagnosis of urinary infections in children can lead to renal damage.
- The optimal timing for initiating treatment to prevent renal sequelae is not well-established.
Purpose of the Study:
- To investigate the impact of early treatment initiation on preventing renal damage in children with febrile urinary infections.
- To determine the critical time window for treatment to avoid acute pyelonephritis and subsequent renal scarring.
Main Methods:
- Prospective enrollment of young children with their first febrile urinary infection.
- Technetium-99m dimercaptosuccinate renal scintigraphy performed within 120 hours of treatment initiation.
- Repeat scintigraphy after 1 year for patients with abnormal initial findings and antibiotic treatment.
Main Results:
- No focal defects were observed in children treated within 24 hours (0/14).
- Focal defects were identified in 1/3 children treated between 24-48 hours and 2/5 treated between 48-72 hours.
- All patients with abnormal findings showed resolution of defects on repeat scintigraphy after treatment.
Conclusions:
- Initiating treatment for febrile urinary infections within 24 hours of fever onset is crucial for preventing renal changes.
- Fever lasting over 24 hours before diagnosis signifies a high risk for renal damage, requiring immediate effective treatment.
Abstract:
Diagnosis of urinary infection in young children is often delayed, which may result in renal damage. However, it remains to be clarified how soon the treatment should be started to prevent renal changes. The present study prospectively enrolled young children with diagnosis of their first febrile urinary infection who underwent technetium-99m dimercaptosuccinate renal cortical scintigraphy within 120 h of initiation of treatment. Patients with abnormal renoscintigraphy received antibiotics for 2 weeks and scintigraphy was repeated 1 year later. Twenty-two children were enrolled from July 1995 through March 2000. Acute-phase renoscintigraphy identified focal defects in 0 of the 14 children who were treated within 24 h of the disease, 1 of the 3 treated in 24-48 h, and 2 of the 5 treated in 48-72 h. Repeat renoscintigraphy showed disappearance of the focal defects in all 3 children. The present study has shown that early treatment within 24 h of onset of the fever due to urinary infection should deter renal changes. Fever for more than 24 h prior to diagnosis indicates a high risk for renal changes and needs an immediate effective treatment to avoid renal damage.
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