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Risk of renal scarring in children with a first urinary tract infection: A systematic review

Shaikh, N and Ewing, AL and Bhatnagar, S and Hoberman, A (2010) Risk of renal scarring in children with a first urinary tract infection: A systematic review. Pediatrics, 126 (6). 1084 - 1091. ISSN 0031-4005

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Abstract

BACKGROUND: To our knowledge, the risk of renal scarring in children with a urinary tract infection (UTI) has not been systematically studied. OBJECTIVE: To review the prevalence of acute and chronic renal imaging abnormalities in children after an initial UTI. METHODS: We searched Medline and Embase for English-, French-, and Spanish-language articles using the following terms: "Technetium 99mTc dimercaptosuccinic acid (DMSA)," "DMSA," "dimercaptosuccinic," "scintigra*," "pyelonephritis," and "urinary tract infection." We included articles if they reported data on the prevalence of abnormalities on acute-phase (≤15 days) or follow-up (>5 months) DMSA renal scans in children aged 0 to 18 years after an initial UTI. Two evaluators independently reviewed data from each article. RESULTS: Of 1533 articles found by the search strategy, 325 full-text articles were reviewed; 33 studies met all inclusion criteria. Among children with an initial episode of UTI, 57% (95% confidence interval [CI]: 50-64) had changes consistent with acute pyelonephritis on the acute-phase DMSA renal scan and 15% (95% CI: 11-18) had evidence of renal scarring on the follow-up DMSA scan. Children with vesicoureteral reflux (VUR) were significantly more likely to develop pyelonephritis (relative risk [RR]: 1.5 [95% CI: 1.1-1.9]) and renal scarring (RR: 2.6 [95% CI: 1.7-3.9]) compared with children with no VUR. Children with VUR grades III or higher were more likely to develop scarring than children with lower grades of VUR (RR: 2.1 [95% CI: 1.4-3.2]). CONCLUSIONS: The pooled prevalence values provided from this study provide a basis for an evidence-based approach to the management of children with this frequently occurring condition. Copyright © 2010 by the American Academy of Pediatrics.

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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Shaikh, Nnas67@pitt.eduNAS67
Ewing, AL
Bhatnagar, S
Hoberman, A
Date: 1 December 2010
Date Type: Publication
Journal or Publication Title: Pediatrics
Volume: 126
Number: 6
Page Range: 1084 - 1091
DOI or Unique Handle: 10.1542/peds.2010-0685
Schools and Programs: School of Medicine > Pediatrics
Refereed: Yes
ISSN: 0031-4005
Related URLs:
Article Type: Review
MeSH Headings: Child; Cicatrix--etiology; Cicatrix--pathology; Humans; Kidney--pathology; Kidney Diseases--etiology; Kidney Diseases--pathology; Risk Factors; Urinary Tract Infections--complications
PubMed ID: 21059720
Date Deposited: 11 Sep 2012 21:45
Last Modified: 23 Jun 2018 23:55
URI: http://d-scholarship.pitt.edu/id/eprint/14042

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