Acute Lobar Nephronia Is Associated With a High Incidence of Renal Scarring in Childhood Urinary Tract Infections

Urinary tract infections (UTIs) represent a common bacterial cause of febrile illness in children. Of children presenting with a febrile UTI, 25‒40% are found to have vesicoureteral reflux (VUR). Historically, the concern regarding VUR was that it could lead to recurrent pyelonephritis, renal scarring, hypertension, and chronic kidney disease. As a result, many children underwent invasive surgical procedures to correct VUR. We now know that many cases of VUR are low-grade and have a high rate of spontaneous resolution. The roles of surveillance, antibiotic prophylaxis, endoscopic injection, and ureteral reimplantation surgery also continue to evolve. In turn, these factors have influenced the investigation of febrile UTIs.Voiding cystourethrography (VCUG) is the radiographic test of choice to diagnose VUR. Due to its invasive nature and questionable benefit in many cases, the American Academy of Pediatrics (AAP) no longer recommends VCUG routinely after an initial febrile UTI. Nevertheless, these guidelines pre-date the landmark Randomized Intervention of Children with Vesicoureteral Reflux (RIVUR) trial and there continues to be controversy regarding the diagnosis and management of VUR. This paper discusses the current literature regarding radiographic testing in children with febrile UTIs and presents a practical risk-based approach for deciding when to obtain a VCUG.

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Usefulness of parametric renal clearance images in the assessment of basic risk factors for renalnal clearance images in the assessment of basic risk factors for renal scarring in children with recurrent urinary tract infections

Nuclear Medicine Review ◽

10.5603/nmr.2017.0012 ◽

2017 ◽

Vol 20 (2) ◽

pp. 76-80

Author(s):

Ewa Pietrzak-Stelasiak ◽

Małgorzata Bieńkiewicz ◽

Wojciech Woźnicki ◽

Krystyna Bubińska ◽

Magdalena Kowalewska-Pietrzak ◽

...

Keyword(s):

Risk Factors ◽

Urinary Tract ◽

Renal Clearance ◽

Urinary Tract Infections ◽

Renal Scarring ◽

Recurrent Urinary Tract Infections ◽

Tract Infections

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Management of urinary tract infections in children: antimicrobial sensitivity pattern, efficacy and pharmacoeconomics

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20192203 ◽

2019 ◽

Vol 8 (6) ◽

pp. 1361

Author(s):

Nikhil S. Yadav ◽

Swanand S. Pathak

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Renal Scarring ◽

Positive Culture ◽

Cost Effective ◽

E Coli ◽

Antimicrobial Sensitivity ◽

Sensitivity Pattern ◽

Sensitivity Report ◽

Tract Infections

Background: Urinary tract infections are commonly seen in febrile children, high incidence of Vesico Ureteral Reflux (VUR) is frequently seen in paediatric patient which is of concern as it may lead to renal scarring. Despite presence of established clinical guidelines there is disparity amongst physician in the diagnosis and treatment of UTI, some physician prescribes taking into consideration the symptoms, some prescribe on the basis of smell and colour and some rely on urine culture and sensitivity report. There is dearth of studies in many tertiary health care centers regarding antimicrobial use. Authors conducted this study to evaluate antimicrobial sensitivity pattern, efficacy and cost effectiveness of antimicrobials used for UTI in children.Methods: Patients of urinary tract infection <13 years of age were included in the study. Symptoms of patient i.e. pain in abdomen, haematuria, increased frequency of urination and degree of fever were recorded. Efficacy was measured through calculating degree of defervescence per hour. Cost effective model was prepared by calculating cost effective ratio i.e. dividing cost of antimicrobial required to bring down the fever and degree through which fever came down.Results: E. coli was the most common pathogen isolated from urine positive culture (69.07%). Nitrofurantoin has shown highest sensitivity to all uropathogens (72.73%). Cotrimoxazole, ciprofloxacin and nitrofurantoin were found to be most cost effective.Conclusions: In this current study authors found E coli is the most common uropathogen isolated. Ceftriaxone, cefixime, cotrimoxazole and amikacin were found to be most efficacious. Cotrimoxazole, ciprofloxacin and nitrofurantoin were found to be most cost effective.

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