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

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Nader Shaikh1, Amy L Ewing, Sonika Bhatnagar

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

Pediatrics
|November 10, 2010
PubMed

Insights

This study found that 57% of children with a urinary tract infection (UTI) showed acute pyelonephritis, and 15% developed renal scarring. Vesicoureteral reflux (VUR) significantly increased these risks, especially in higher grades.

Area of Science:

  • Pediatric Nephrology
  • Diagnostic Imaging
  • Infectious Diseases

Background:

  • The risk of renal scarring in children following a urinary tract infection (UTI) lacks systematic study.
  • Urinary tract infections are common in children, with potential long-term renal consequences.

Purpose of the Study:

  • To systematically review the prevalence of acute and chronic renal imaging abnormalities in children after an initial UTI.
  • To establish an evidence-based approach for managing pediatric UTIs.

Main Methods:

  • A comprehensive literature search was conducted in Medline and Embase for relevant English, French, and Spanish articles.
  • Studies reporting Technetium (99m)Tc dimercaptosuccinic acid (DMSA) scan data on children (0-18 years) post-UTI were included.
  • Data on acute-phase (≤15 days) and follow-up (>5 months) DMSA scan abnormalities were independently reviewed.

Main Results:

  • Out of 33 included studies, 57% of children exhibited acute pyelonephritis on DMSA scans post-UTI; 15% showed renal scarring on follow-up scans.
  • Children with vesicoureteral reflux (VUR) had a significantly higher risk of developing pyelonephritis (RR: 1.5) and renal scarring (RR: 2.6).
  • Higher grades of VUR (III and above) were associated with an increased likelihood of renal scarring (RR: 2.1) compared to lower grades.

Conclusions:

  • This systematic review provides pooled prevalence data for renal abnormalities following pediatric UTIs.
  • The findings support an evidence-based strategy for managing children diagnosed with urinary tract infections.
  • Understanding the prevalence of renal scarring and pyelonephritis aids in risk stratification and treatment decisions.
Abstract

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