Published online September 1, 2008
PEDIATRICS Vol. 122 No. 3 September 2008, pp. 486-490 (doi:10.1542/peds.2007-2894)

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ARTICLE

Early Treatment of Acute Pyelonephritis in Children Fails to Reduce Renal Scarring: Data From the Italian Renal Infection Study Trials

Ian K. Hewitt, MBBS, FRACP^a, Pietro Zucchetta, MD^b, Luca Rigon, MD^c, Francesca Maschio, MD^d, Pier Paolo Molinari, MD^e, Lisanna Tomasi, MD^f, Antonella Toffolo, MD^g, Luigi Pavanello, MD^h, Carlo Crivellaro, MDⁱ, Stefano Bellato, MD^j and Giovanni Montini, MD^f

^a Department of Pediatric Nephrology, Princess Margaret Hospital, Perth, Australia; Departments of
^b Nuclear Medicine
^f Pediatric Nephrology, Azienda Ospedaliera-University of Padua, Padua, Italy
^c Pediatric Unit, Camposampiero Hospital, Padua, Italy
^d Pediatric Unit, Mestre Hospital, Mestre, Italy
^e Pediatric Unit, Bologna General Hospital, Bologna, Italy
^g Pediatric Unit, Motta di Livenza Hospital, Livenza, Italy
^h Pediatric Unit, Castelfranco Hospital, Castelfranco, Italy
ⁱ Pediatric Unit, Chioggia Hospital, Chioggia, Italy
^j Pediatric Unit, Arzignano Hospital, Arzignano, Italy

OBJECTIVES. The American Academy of Pediatrics recommendation for febrile infants and young children suspected of having a urinary tract infection is early antibiotic treatment, given parenterally if necessary. In support of this recommendation, data suggesting that delay in treatment of acute pyelonephritis increases the risk of kidney damage are cited. Because the risk was not well defined, we investigated renal scarring associated with delayed versus early treatment of acute pyelonephritis in children.

METHODS. The research findings are derived from 2 multicenter, prospective, randomized, controlled studies, Italian Renal Infection Study 1 and 2, whose primary outcomes dealt with initial antibiotic treatment and subsequent prophylaxis, respectively. From the 2 studies, we selected the 287 children with confirmed pyelonephritis on acute technetium-99m-dimercaptosuccinic acid scans who underwent repeat scanning to detect scarring 12 months later. The children were 1 month to <7 years of age when they presented with their first recognized episode of acute pyelonephritis in northeast Italy.

RESULTS. Progressive delay in antibiotic treatment of acute pyelonephritis from <1 to 5 days after the onset of fever was not associated with any significant increase in the risk of scarring on technetium-99m-dimercaptosuccinic acid scans obtained 1 year later. The risk of scarring remained relatively constant at 30.7 ± 7%. Clinical and laboratory indices of inflammation were comparable in all groups, as was the incidence of vesicoureteric reflux.

CONCLUSIONS. Early treatment of acute pyelonephritis in infants and young children had no significant effect on the incidence of subsequent renal scarring. Furthermore, there was no significant difference in the rate of scarring after acute pyelonephritis when infants and young children were compared with older children.

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Key Words: urinary tract infection • renal scar • technetium-99m-dimercaptosuccinic acid scan • antibiotic treatment

Abbreviations: IRIS—Italian Renal Infection Study • DMSA—technetium-99m-dimercaptosuccinic acid • UTI—urinary tract infection

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Accepted Dec 4, 2007.

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eLetters:

Read all eLetters

Early treatment of acute pyelonephritis is still mandatory

José Manuel Fernández-Menéndez, et al.

Pediatrics Online, 4 Sep 2008 [Full text]

Results needs to be qualified

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Pediatrics Online, 5 Nov 2008 [Full text]