Published online June 29, 2009
PEDIATRICS Vol. 124 No. 1 July 2009, pp. 23-29 (doi:10.1542/peds.2008-1192)

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ARTICLE

Age-Related Renal Parenchymal Lesions in Children With First Febrile Urinary Tract Infections

Paolo Pecile, MD^a, Elisabetta Miorin, MD^a, Carla Romanello, MD^a, Enrico Vidal, MD^a, Marzia Contardo, MD^a, Francesca Valent, MD^b and Alfred Tenore, MD^a

^a Department of Pediatrics, DPMSC
^b Institute of Hygiene and Epidemiology, University of Udine, School of Medicine, Udine, Italy

OBJECTIVE: The aim of this study was to define the association between age and the occurrence of acute pyelonephritis and renal scars.

METHODS: Between 1999 and 2002, all children 0 to 14 years of age consecutively seen with a first febrile urinary tract infection were enrolled in the study. ^99mTc-Dimercaptosuccinic acid renal scintigraphy was performed within 5 days after admission for the detection of renal parenchymal involvement. The presence of vesicoureteral reflux was assessed by using cystography performed 1 month after the infection. If the acute scan results were abnormal, then follow-up ^99mTc-dimercaptosuccinic acid scanning was performed after 6 months, to assess the frequency of scars.

RESULTS: A total of 316 children were enrolled in the study (190 children <1 year, 99 children 1–4 years, and 27 children 5–14 years of age). ^99mTc-Dimercaptosuccinic acid scintigraphy revealed that 59% of the children had renal involvement in the acute phase of infection. The frequency of kidney involvement in infants <1 year of age (49%) was significantly lower than that in children 1 to 4 years of age (73%) and >5 years of age (81%). Of the 187 children with positive acute ^99mTc-dimercaptosuccinic acid scan results, 123 underwent repeat scintigraphy after 6 months. Renal scars were found for 28% of children <1 year, 37% of children 1 to 4 years, and 53% of children 5 to 14 years of age. No significant differences in the frequency of scars and the presence or absence of vesicoureteral reflux were noted.

CONCLUSIONS: Our findings confirm that acute pyelonephritis and subsequent renal scarring occur only in some children with first febrile urinary tract infections. Children <1 year of age with febrile urinary tract infections have a lower risk of parenchymal localization of infection and renal scarring.

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Key Words: acute pyelonephritis • children • vesicoureteral reflux • renal scarring

Abbreviations: UTI—urinary tract infection • APN—acute pyelonephritis • DMSA—^99mTc-dimercaptosuccinic acid • SPECT—single photon emission computed tomography • VUR—vesicoureteral reflux • ESR—erythrocyte sedimentation rate • CRP—C-reactive protein • WBC—white blood cell • TLR4—Toll-like receptor 4 • OR—odds ratio • CI—confidence interval

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Accepted Nov 14, 2008.

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