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Published on: August 5, 2010
Renal scarring following urinary tract infections in children
Balakrishna Bandari1, Seema Pavaman Sindgikar1, Soma Santosh Kumar1
1Department of Pediatrics, K. S. Hegde Medical Academy, Mangalore, NITTE University, Mangalore, India.
Insights
Recurrent urinary tract infections (UTIs) in children are linked to renal scarring, especially with vesicoureteral reflux (VUR). Dimercaptosuccinic acid (DMSA) scans are effective for monitoring scarring in pediatric UTI cases.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Diagnostic Imaging
Background:
- Urinary tract infection (UTI) is a common pediatric bacterial infection.
- Vesicoureteral reflux (VUR) is a significant risk factor for renal scarring post-UTI in children.
Purpose of the Study:
- To investigate renal scarring following UTI in children using dimercaptosuccinic acid (DMSA) scans.
- To identify clinical and diagnostic factors associated with recurrent UTIs and renal scarring.
Main Methods:
- A 24-month cross-sectional study of 40 infants and children diagnosed with UTI.
- Clinical presentation, laboratory data, micturating cystourethrogram, and DMSA scans were documented.
- DMSA scans were used to confirm renal scar formation during follow-up.
Main Results:
- UTI was more prevalent in males.
- Children with a history of recurrent UTIs showed a higher incidence of renal scarring.
- Significant associations were found between recurrent UTIs and *Escherichia coli* ( *E. coli* ) infection (p=0.007), higher VUR grades (p=0.006), and renal scar formation (p=0.041).
- High-grade antenatal hydroureteronephrosis, febrile UTI, younger age, and *E. coli* UTI were strongly linked to recurrent UTIs and renal scarring.
Conclusions:
- Dimercaptosuccinic acid (DMSA) scan is a preferred non-invasive method for monitoring children with recurrent UTIs.
- Early identification and management of factors like VUR and *E. coli* infections are crucial in preventing renal scarring in pediatric UTI cases.
Abstract:
Urinary tract infection (UTI) is the most common bacterial infection seen in younger age group children. The most common risk factor for renal scarring in children with post-UTI is vesicoureteral reflux (VUR). This study looked at renal scarring following UTI in children by dimercaptosuccinic acid (DMSA) scan. It is a cross-sectional time bound study done among 40 infants and children with UTI for a period of 24 months. Their clinical presentation and laboratory data, including micturating cystourethrogram, were documented. DMSA scan, done during the follow-up, established the presence of renal scars if any. UTI was more common in males. Children with history of recurrent UTI had renal scarring. Statistical significance was noted when first and recurrent attacks of UTI were compared for clinical and diagnostic characteristics like Escherichia coli UTI (p = 0.007), increasing grades of VUR (p = 0.006) and renal scar formation (p = 0.041). The study concluded that the high grades of antenatal hydroureteronephrosis (100%), febrile UTI (34%), younger age group (67.5%) and E. coli UTI (86%) were more associated with recurrent attacks of UTI and renal scarring. DMSA, being the non-invasive test, is better proven to be an investigation of choice than other invasive modalities for follow-up of children with recurrent attacks of UTI.
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