Recurrent Febrile Urinary Tract Infections and Renal Scarring

In this issue of JAMA Pediatrics, Shaikh et al continue to shed light on important aspects of urinary tract infections (UTIs) in children based on data gleaned from the Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) and Careful Urinary Tract Infection Evaluation (CUTIE) trials. The study by Shaikh et al addresses the likelihood of new renal scars developing after a first febrile UTI and after recurrent UTIs. Three decades ago, the pioneering group in Sweden identified a slight increase in renal scarring from the first UTI to the second and from the second to the third; only after 3 UTIs did the rate increase dramatically. However, as Shaikh et al point out, the data on the association between renal scars and recurrent UTIs were based on pyelography with an intravenous contrast agent ( “intravenous pyelography,” or IVP). A decade after their original report, the group in Sweden compared the IVP results with the results using the newly available technetium 99m dimercaptosuccinic acid scan technique and found, as expected, that the latter was more sensitive. Until now, the origi nal data on the association between recurrent UTIs and scarring stood unchallenged; Shaikh et al bring us up to date. The authors report an overall rate of scarring far lower than the rates in current trials and systematic reviews, at least in part because they took pains to focus on new scars, excl uding individuals whose baseline scan on entry into the trials reveal...
Source: JAMA Pediatrics - Category: Pediatrics Source Type: research

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CONCLUSIONS: The Tc-99m DMSA scan remains the gold standard to detect renal parenchymal anomalies. A different length between the kidneys>1.11 SDS and dilated VUR are predictors of abnormal Tc-99m DMSA renal scan. PMID: 31726462 [PubMed - as supplied by publisher]
Source: Pediatric Research - Category: Pediatrics Authors: Tags: Pediatr Res Source Type: research
Abstract In terms of treatment planning, the radiologic phenomenon of vesicoureteric reflux has become less important than its inherent risk of further urinary tract infections and loss of renal function. Whilst radiologic and sonographic voiding cystourethrography continues to be the gold standard in the mere detection of vesicoureteric reflux, dimercaptosuccinic acid scanning is important for risk stratification. Also it serves to confirm renal involvement in uncertain situations with urinary tract infection and fever. In older children, it is the standard in primary diagnostics. Furthermore, it enables the diag...
Source: Aktuelle Urologie - Category: Urology & Nephrology Authors: Tags: Aktuelle Urol Source Type: research
Ş Abstract Gültekin ND, Benzer M, Tekin-Neijmann Ş. Is there any relation between connective tissue growth factor and scar tissue in vesicoureteral reflux. Turk J Pediatr 2019; 61: 71-78. Vesicoureteral reflux (VUR) is the most common uropathy in childhood which leads to increased frequency of urinary tract infection (UTI) and renal scarring. Connective tissue growth factor (CTGF) plays an important role in the development of glomerular and tubulointerstitial fibrosis in progressive kidney diseases. The aim of this study was to investigate the relation between urinary CTGF and renal damage resulted from VU...
Source: The Turkish Journal of Pediatrics - Category: Pediatrics Authors: Tags: Turk J Pediatr Source Type: research
An 82-year-old male, with a history of bowel cancer with partial colectomy, gastroesophageal reflux disease, remote partial gastrectomy for peptic ulcer disease, and no documented prior kidney disease, presents with several months of fatigue and subacute decline in kidney function. He had no history of diabetes, hypertension, kidney stones, or prior urinary tract infections. He denied use of nonsteroidal anti-inflammatory agents, herbal medications, and recent antibiotics. There was no family history of renal disease.
Source: Kidney International - Category: Urology & Nephrology Authors: Tags: Make Your Diagnosis Source Type: research
Authors: Roy P, S R, MittalMittal R, Mehta S Abstract Vesicoureteral reflux (VUR) in children is often treated with antimicrobials for prolonged durations, which often leads to antimicrobial resistance. In this context, this review article discusses the use of endoscopic injection in VUR as a safe and efficacious option for these children. The literature pertaining to VUR- its clinical manifestation and management, antibiotic resistance- with special reference to management of VUR, and endoscopic dextranomer/hyaluronic acid gel injection for management of VUR was reviewed by identifying key words in a PubMed search...
Source: Journal of the Association of Physicians of India - Category: General Medicine Tags: J Assoc Physicians India Source Type: research
AbstractObjectiveVesicoureteral reflux (VUR) is a major risk factor for recurrent symptomatic urinary tract infection (UTI) in pediatric patients. In addition, dimercaptosuccinic acid renal scintigraphy (DMSA) is an important diagnostic modality of VUR. However, the value of DMSA for predicting recurrent pediatric UTI has not been studied. Therefore, we aimed to develop visual scoring system (VSS) with DMSA to predict the risk of recurrence of symptomatic urinary tract infection in pediatric patient under the age of 24  months.MethodsPediatric UTI patients who visited our tertiary hospital emergency department and und...
Source: Annals of Nuclear Medicine - Category: Nuclear Medicine Source Type: research
ConclusionsA bilateral duplex collecting system with refluxing upper pole moiety ureter is a very rare entity. The diagnosis should be suspected when exploring any flank pain with recurrent urinary tract infections to avoid subsequent renal impairment. Furthermore, this case shows how some common symptoms may lead to finding an unexpected urinary tract abnormality.
Source: Journal of Medical Case Reports - Category: General Medicine Source Type: research
Conclusions: First UTI in a group of Thai children occurred in approximately equal proportion in boys and girls but boys were younger at diagnosis. Kidney and urinary tract anomalies were detected in half of the children.Urol Int
Source: Urologia Internationalis - Category: Urology & Nephrology Source Type: research
ConclusionsIn older children, the normal late DMSA scan predicted the absence of high-grade VUR, obviating the need for a VCUG. This approach could be a possible strategy for children not studied at acute infection time.
Source: Indian Journal of Pediatrics - Category: Pediatrics Source Type: research
CONCLUSIONS: Compared with no treatment, the use of long-term, low-dose antibiotics may make little or no difference to the number of repeat symptomatic and febrile UTIs in children with VUR (low certainty evidence). Considerable variation in the study designs and subsequent findings prevented drawing firm conclusions on efficacy of antibiotic treatment.The added benefit of surgical or endoscopic correction of VUR over antibiotic treatment alone remains unclear since few studies comparing the same treatment and with relevant clinical outcomes were available for analysis. PMID: 30784039 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - Category: General Medicine Authors: Tags: Cochrane Database Syst Rev Source Type: research
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