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Development of new renal scars: a collaborative study
Insights
Early diagnosis and prompt treatment are crucial for preventing kidney scarring in children with urinary tract infections. Even children over age 5 remain vulnerable to developing new renal scars.
Area of Science:
- Pediatrics
- Nephrology
- Radiology
Background:
- Renal scarring in children can result from urinary tract infections (UTIs).
- Factors influencing the development of new renal scars require further investigation.
- Understanding these factors is essential for effective prevention and management strategies.
Purpose of the Study:
- To analyze clinical data and serial radiographs of infants and children to identify factors contributing to renal scar development.
- To assess the incidence and extent of new renal scarring in a pediatric cohort.
- To evaluate the impact of delayed diagnosis, recurrent infections, and vesicoureteric reflux on renal scar formation.
Main Methods:
- Retrospective analysis of clinical data and serial radiographs from 74 children (66 girls, 8 boys) without duplex kidney or obstruction.
- Radiological assessment for the development of new renal scars.
- Correlation of scarring with factors such as age at scarring, history of urinary infection, vesicoureteric reflux, and management delays.
Main Results:
- New renal scars developed in 87 kidneys (74 previously normal, 13 previously scarred); extensive scarring occurred in 16 kidneys.
- Urinary infection was present in all children; diagnosis and treatment were delayed in 45, and 58 experienced recurrent infections.
- Vesicoureteric reflux was observed in 67 children, and social problems impacted management in 22.
- Thirty-four children were aged 5 or older when scarring occurred.
Conclusions:
- Early diagnosis, prompt and effective treatment, thorough investigation, and long-term supervision are critical for reducing renal scarring in children with UTIs.
- Children over the age of 5 remain susceptible to developing renal scars.
- Inadequate management, including delayed diagnosis and insufficient prophylaxis, contributes significantly to renal scar progression.
Abstract:
In a study of the factors surrounding the development of renal scars clinical data and serial radiographs were analysed in 74 infants and children (66 girls and eight boys) without duplex kidney or obstruction. The development of new scars was seen radiologically in 87 kidneys (74 previously normal and 13 previously scarred). New scarring was extensive in 16 kidneys. Thirty four children were aged 5 or over when scarring occurred. Urinary infection occurred in all the children. Diagnosis and effective treatment were delayed in 45 of them; 58 suffered further urinary infections between the baseline intravenous urogram and the first showing new scarring. Vesicoureteric reflux was seen in 67 of the children. Investigation and treatment varied widely, and few children received long term prophylaxis. Social problems interfered with the management of 22 children. Early diagnosis, prompt effective treatment, investigation, and long term supervision of children with urinary infection are essential if renal scarring is to be reduced; those over the age of 5 are still vulnerable.