Early treatment of acute pyelonephritis in children fails to reduce renal scarring: Data from the italian renal infection study trials

Ian K. Hewitt, Pietro Zucchetta, Luca Rigon, Francesca Maschio, Pier Paolo Molinari, Lisanna Tomasi, Antonella Toffolo, Luigi Pavanello, Carlo Crivellaro, Stefano Bellato, Giovanni Montini

Research output: Contribution to journalArticlepeer-review

Abstract

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 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.

Original languageEnglish
Pages (from-to)486-490
Number of pages5
JournalPediatrics
Volume122
Issue number3
DOIs
Publication statusPublished - Sep 2008

Keywords

  • Antibiotic treatment
  • Renal scar
  • Technetium-99m-dimercaptosuccinic acid scan
  • Urinary tract infection

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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