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[Follow-up and prognosis of pyelonephritis in infancy]
1Klinik für Kinder- und Jugendmedizin Jussuf Ibrahim des Klinikums, Friedrich-Schiller-Universität Jena.
Insights
Early detection and prompt treatment of pyelonephritis (PN) in infants are crucial. Prompt diagnosis and management, including voiding cystography for infants with PN, can reduce renal scarring and improve outcomes, especially in cases with vesico-uretero-renal reflux (VUR).
Area of Science:
- Pediatric Nephrology
- Pediatric Urology
- Infectious Diseases in Children
Context:
- Pyelonephritis (PN) is a serious kidney infection in infants, potentially leading to renal scarring and long-term damage.
- Vesico-uretero-renal reflux (VUR) is a common complication associated with PN, increasing the risk of recurrent infections and kidney damage.
- Urinary tract obstructions can exacerbate the severity and complications of PN.
Purpose:
- To investigate the incidence and impact of vesico-uretero-renal reflux (VUR) in infants with their first episode of pyelonephritis (PN).
- To evaluate the effectiveness of medical and surgical management of VUR on preventing recurrent infections and renal scarring.
- To identify key strategies for reducing renal damage and improving prognosis in infants diagnosed with PN.
Summary:
- This study followed 128 infants (1-18 months) with first-time PN. Renal scarring occurred in 20% of non-obstructive PN cases, significantly higher (39%) in those with VUR (grades III-IV).
- Recurrent urinary tract infections (UTIs) were equally frequent in children with and without VUR, but VUR cases showed more PN and renal scarring.
- Early detection of obstruction, prompt PN diagnosis with delayed antibiotic therapy, and voiding cystography in infants with PN are recommended. Long-term chemoprophylaxis is advised for children with VUR.
Impact:
- Implementing early detection of urinary tract obstructions via sonographic screening can prevent severe kidney damage.
- Timely diagnosis and treatment of PN, alongside appropriate management of VUR, significantly reduce the risk of renal scarring and improve long-term outcomes in infants.
- Routine voiding cystography in infants with PN and long-term chemoprophylaxis for VUR are essential for preventing recurrent infections and preserving renal function.
Abstract:
128 infants between 1 and 18 months, 80 girls and 48 boys suffering from their first pyelonephritis (PN), were investigated and followed up over 2.9 +/- 2.2 years (mean +/- SD). 20 children showed urinary tract obstructions. In 49 of 108 cases (45%) with nonobstructive PN a vesico-uretero-renal reflux (VUR) was found and surgically corrected in 13 cases. In 36 patients (52 renal units) the VUR disappeared in most cases under medical management within 3 years. Recurrences of urinary tract infections (UTI) were found in the same frequency in children with and without reflux (28%), but those with VUR showed significantly more PN. 22 of 108 patients with nonobstructive PN (20%) developed renal scars, 39% of children with reflux (mostly VUR III. or IV. degree), 5% of those without reflux. In more than half of these cases renal scars were found already after the first PN. We conclude that a reduction of the risk of renal damage and an improvement of the prognosis can achieved by the following measures: 1. early detection of obstruction by pre- or postnatal sonographic screening, 2. early and exact diagnosis of PN and antibiotic therapy without delay. PN has to be excluded in all infants with unclear fever. 3. In all infants with PN a voiding cystography should be performed. In children with VUR, long-term chemoprophylaxis is necessary to avoid recurrence of PN.