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[Parenchymatous cicatrix and urinary tract infection: physiopathology and clinical implications]
Insights
Renal scarring in children, a complication of acute pyelonephritis, can impair kidney growth. Early, aggressive treatment of infections is crucial for prevention.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
Context:
- Acute pyelonephritis in children can lead to long-term renal scarring.
- The exact prevalence and relationship with other conditions like reflux nephropathy are unclear.
- Scarring involves focal interstitial fibrosis, potentially compromising renal growth if it occurs in infancy.
Purpose:
- To clarify the understanding of renal scarring post-acute pyelonephritis in children.
- To highlight the diagnostic role of dimercaptosuccinic acid (DMSA) scans.
- To emphasize the importance of early and aggressive infection management.
Summary:
- Renal scarring is a primary long-term complication of acute pyelonephritis in children.
- Dimercaptosuccinic acid (DMSA) scans are the current standard for assessing renal scars.
- Extensive scarring can lead to reduced glomerular filtration rate (GFR) and hypertension.
Impact:
- Early and aggressive treatment of acute pyelonephritis is essential for preventing renal scarring.
- Conservative management is recommended for established renal scarring.
- Understanding renal scarring impacts pediatric kidney health and long-term outcomes.
Abstract:
Renal scarring is the main long term complication of acute pyelonephritis in children. The prevalence rate is hazardous since data from the literature are confusing with respect to reflux nephropathy, chronic pyelonephritis and renal hypoplasia. The pathology of such lesions consists in focal interstitial fibrosis. When the first pyelonephritic attack occurs during infancy, renal growth may be compromised. The current approach of renal scar assessment is based on dimercaptosuccinic acid (DMSA) scan. Bilateral extensive lesions may be responsible for altered glomerular filtration rate (GFR) and/or arterial hypertension. The management of overt scarring is conservative and careful prevention must be based on early and aggressive treatment of acute pyelonephritis.