Primary and acquired renal scarring in boys and girls with urinary tract infection,☆☆,

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Abstract

Objectives: To determine when pyelonephritic renal scarring was detected in children with urinary tract infection (UTI) and characterize those with primary and acquired scarring, respectively. Study design: A population-based cohort of 1221 children (989 girls and 232 boys) with first recognized symptomatic UTI, aged 0 to 15 years, were diagnosed and followed up prospectively at a single children’s hospital; 652 had febrile UTI. Seven hundred fifty-three were evaluated by urography. Renal scarring was classified as primary or acquired, the latter without signs of scarring at the first investigation. To evaluate the frequency of recurrent UTI in those with acquired scarring, a comparison with group-matched children without scarring was performed. Results: A total of 74 children without obstruction had renal scarring (acquired in 40). Primary scarring was found in 18 of 21 (86%) of the boys and 16 of 53 (30%) of the girls (P < .001). The majority of boys with scarring had dilated reflux (67%) in contrast to girls (23%). Recurrent UTI was rare in boys, whereas girls with acquired scarring had significantly more febrile recurrences than girls without scarring. Conclusions: Most boys had primary, probably congenital, reflux-associated renal damage, whereas most girls had acquired scarring related to recurrences of febrile UTI. (J Pediatr 2000;136:30-4)

Section snippets

METHODS

The pediatric medical care organization in Göteborg has previously been described.9 Since the early 1960s, most children with UTI in this distinct geographic area have been treated at the children’s hospital. During the late 1970s, 86% of the children with febrile UTI in the city were primarily treated at the hospital10 and followed up at a special UTI clinic, which provides continuity and uniform handling.9 In short, for all children younger than 1 year and all with febrile infections,

Primary and Acquired Renal Scarring

Seventy-four children, 21 boys and 53 girls, were found to have renal scarring. In 10 children, 4 boys and 6 girls, the scarring was bilateral. The scarring was primary, that is, seen on the first urogram, in 34. Of these, 4 boys and 2 girls initially had isolated calyceal deformity and 2 boys had isolated parenchymal thinning. Acquired scarring was found in 40 children; median time from the first UTI to detection of scarring was 3.1 years (mean, 3.7 years). Boys had primary scarring

DISCUSSION

In this study a population-based group of children, ascertained during a 10-year period, was followed after their first known UTI. Age at detection was low, with the highest rate of first febrile infections during infancy in both girls and boys,12 and the probability of previous undetected infections can be considered low. Both these factors, an unselected patient population and early detection of infections, are essential when describing development of pyelonephritic renal scarring. Because

Acknowledgements

We thank Henrik Ahlbom for advice and assistance with statistical analyses.

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  • Cited by (0)

    Supported by the Swedish Medical Research Council, the Skandia Life Insurance Company, the Frimurare-Barnhusdirektionen, and the Gothenburg Medical Society.

    ☆☆

    Reprint requests: Martin Wennerström, Department of Pediatrics, Sahlgrenska University Hospital/East, S-416 85 Göteborg, Sweden.

    0022-3476/2000/$12.00 + 0  9/21/102615

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