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Risk factors in the development of early renal cortical defects in children with urinary tract infection
M R Ditchfield1, J F de Campo, T M Nolan
1Department of Radiology, Royal Children's Hospital, Melbourne, Australia.
Insights
Early kidney defects in children with urinary tract infections are linked to younger age and vesicoureteral reflux. However, reflux may contribute less to scarring than previously thought.
Area of Science:
- Pediatric Nephrology
- Radiology
- Infectious Diseases
Background:
- Cortical defects on renal scintigraphy in children with urinary tract infections (UTIs) can indicate acute inflammation or scarring.
- Understanding the factors influencing these defects is crucial for early diagnosis and management.
Purpose of the Study:
- To investigate the relationship between early cortical defects and patient age, sex, vesicoureteral reflux (VUR) grade, and causative organism in children following their first UTI.
Main Methods:
- Prospective study of 193 children under 5 with their first confirmed UTI.
- Renal cortical scintigraphy and voiding cystourethrography performed within 15 days of diagnosis.
- Analysis of associations between cortical defects and demographic/clinical factors.
Main Results:
- Cortical defects were more prevalent in children under 2 years old (33%) and those with VUR (45%).
- VUR was absent in 63% of kidneys with defects, suggesting other contributing factors.
- Younger children (<2 years) had a higher prevalence and severity of VUR.
Conclusions:
- Early cortical defects are associated with younger age and VUR, but this link is influenced by age-related reflux changes.
- A significant number of defects occur without VUR, indicating its contribution to scarring may be overestimated.
Objective:
Defects seen on early cortical scintigrams of the renal cortex in children with urinary tract infection may represent acute inflammatory change or established scar. The purpose of this study was to determine the relationship between these defects and age, sex, the presence and grade of vesicoureteral reflux, and infective organism in a cohort of children examined after their first proved urinary tract infection.
Subjects And Methods:
We prospectively examined 193 consecutive patients less than 5 years old who were seen at the ambulatory pediatric department during a 3-year period and had a first proved urinary tract infection. Children with obstructed or solitary kidneys were excluded. All patients were imaged with scintigraphy of the renal cortex and radiographic voiding cystourethrography within 15 days of diagnosis. The association of age, sex, the presence and grade of vesicoureteral reflux, and infective organism with a defect (acute pyelonephritis or a renal scar) seen on a cortical renal scan was studied.
Results:
The prevalence of cortical defects was greater in the kidneys of patients less than 2 years old (96/290, 33%) than in older children (16/96, 17%) and greater in those with vesicoureteral reflux (41/92, 45%) than in those without it (71/294, 24%). Vesicoureteral reflux was absent in 63% (71/112) of kidneys with a cortical defect. No association with sex or infective organism was established. As well as having a greater prevalence of cortical defects, 145 (75%) of the 193 urinary tract infections included in the study were in children less than 2 years old. The kidneys of these younger patients also had a greater severity and prevalence of vesicoureteral reflux (74/290, 26%) than did those of older children (18/96, 19%).
Conclusion:
Early cortical defects are associated with an age less than 2 years and vesicoureteral reflux. However, the association of early defects with the presence and grade of vesicoureteral reflux is confounded by the declining prevalence and severity of reflux with age. A significant proportion of cortical defects occur in the absence of vesicoureteral reflux, and the contribution of reflux to scar formation might be less than previously considered.