Related Experiment Videos
Renal scarring after acute pyelonephritis
B Jakobsson1, U Berg, L Svensson
1Department of Paediatrics, Huddinge University Hospital, Karolinska Institute, Sweden.
Insights
Renal scarring after acute pyelonephritis in children is common, even without known risk factors like vesicoureteric reflux (VUR). This study highlights the frequent occurrence of kidney damage following childhood urinary tract infections.
Area of Science:
- Pediatric Nephrology
- Diagnostic Imaging
- Infectious Diseases
Background:
- Acute pyelonephritis is a common childhood infection.
- Renal scarring can result from pyelonephritis, potentially leading to long-term complications.
- The incidence and risk factors for renal scarring require further elucidation.
Purpose of the Study:
- To prospectively evaluate the incidence and progression of renal scarring after acute pyelonephritis in children.
- To identify risk factors associated with renal scarring in this population.
- To assess the correlation between vesicoureteric reflux (VUR) and renal scarring.
Main Methods:
- Prospective study of 76 children (aged 0-15.9 years) with acute pyelonephritis.
- Technetium-99m dimercaptosuccinic acid (DMSA) scans performed during infection, at 2 months, and at 2 years post-infection.
- Micturition cystourethrogram (MCU) performed at 2 months to assess for VUR.
Main Results:
- Renal changes on DMSA scans were observed in 86% during infection, decreasing to 59% at 2 months and 37% at 2 years.
- Vesicoureteric reflux (VUR) was detected in 25% of children at 2 months.
- Renal scarring was correlated with gross VUR and recurrent pyelonephritis, but 62% of scarred kidneys had no VUR; older age at infection was also a risk factor.
Conclusions:
- Renal scarring after acute pyelonephritis in children is more frequent than previously recognized.
- While gross VUR and recurrent infections increase risk, renal scarring often occurs in their absence.
- The findings underscore the importance of early diagnosis and monitoring for potential long-term renal damage in children with pyelonephritis.
Abstract:
Seventy six children, 18 boys and 58 girls, aged 0-15.9 (median 1.0) years, with acute pyelonephritis were prospectively studied with a technetium-99m dimercaptosuccinic acid (DMSA) scan during infection and two months later. Fifty nine of these children were also studied two years after the infection. Seventeen children with a normal DMSA scan during infection or at two months after infection, or both, were not investigated by a DMSA scan at two years after acute pyelonephritis. A micturition cystourethrogram was performed in all the children after two months. Changes on the DMSA scan were found in 65 (86%) children during acute pyelonephritis, in 45 (59%) children at two months, and in 28 (37%) children at two years after infection. Vesicoureteric reflux (VUR) was found in 19 (25%) children at two months. Renal scarring was significantly correlated with the presence of gross VUR and recurrent pyelonephritis, but 62% of the scarred kidneys were drained by non-refluxing ureters. Children with scars were older at the time of acute pyelonephritis than those without scars but no difference was found between the groups with regard to duration of illness, levels of C reactive protein and maximum white cell count, glomerular filtration rate, nor renal concentration capacity at the time of infection. It is concluded that renal scarring after acute pyelonephritis in children is more common than has been previously thought. Although children with gross VUR and recurrent pyelonephritis are at the greatest risk, renal scarring is more often seen without these risk factors.