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Impressive renal damage after acute pyelonephritis in a child

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Abstract

Urinary tract infection (UTI) is one of the most common bacterial infections in children, and its role in the pathogenesis of scarred kidney is debated. We report on a 7-year-old child who presented with severe UTI. The early (day 4) renal computed tomography (CT) scan showed normal-sized kidneys (110 mm on the left, 105 mm on the right), whereas the control CT scan and dimercaptosuccinic acid (DMSA) scan, performed 1 and 2 months later, respectively, showed a small scarred right kidney (60 mm) with a 12% residual function. An intermittent right vesicoureteral reflux (VUR) was diagnosed by direct isotopic cystography and then treated by Cohen vesicoureteral reimplantation. The patient remained free of infectious recurrence, hypertension, or renal function decrease. This report demonstrates that one episode of acute pyelonephritis can lead to severe renal scarring. Whereas antenatal lesions are thought to have a stronger role in the causal pathway for reflux nephropathy than is UTI in addition to VUR, this observation reminds us that UTI can truly play an important role in damaging kidneys.

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Fig. 1

Abbreviations

APN:

Acute pyelonephritis

DMSA:

Dimercaptosuccinic acid

MRI:

Magnetic resonance imaging

UTI:

Urinary tract infection

VUR:

Vesicoureteral reflux

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Acknowledgements

We gratefully thank O. Lefur for her photographic assistance and S. Fargue for helpful discussions.

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Authors and Affiliations

  1. Department of Pediatric Nephrology, Armand Trousseau Hospital, AP-HP, Pierre et Marie Curie University, Paris, France

    Sandrine Leroy, Tim Ulinski & Albert Bensman

  2. Department of Pediatrics, Saint-Vincent-de-Paul Hospital, AP–HP, Université Paris-Descartes, Paris, France

    Sandrine Leroy, Martin Chalumeau, François Dubos & Dominique Gendrel

  3. Pediatric Emergency Unit and Infectious Diseases, University Hospital, Lille, France

    François Dubos

  4. Department of Nuclear Medicine, Armand Trousseau Hospital, AP-HP, Pierre et Marie Curie University, Paris, France

    Aline Sergent-Alaoui

  5. Department of Pediatric Radiology, Saint-Vincent-de-Paul Hospital, AP–HP, Université Paris-Descartes, Paris, France

    Valérie Merzoug

  6. Department of Pediatric Radiology, Armand Trousseau Hospital, AP-HP, Pierre et Marie Curie University, Paris, France

    Hubert Ducou-le-Pointe

  7. Department of Pediatric Surgery, Armand Trousseau Hospital, AP-HP, Pierre et Marie Curie University, Paris, France

    Georges Audry

  8. Centre for Statistics in Medicine, University of Oxford, Wolfson College Annexe, Linton Road, Oxford, OX2 6UD, UK

    Sandrine Leroy

Authors
  1. Sandrine Leroy
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  2. Martin Chalumeau
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  3. Tim Ulinski
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  4. François Dubos
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  5. Aline Sergent-Alaoui
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  6. Valérie Merzoug
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  7. Hubert Ducou-le-Pointe
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  8. Georges Audry
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  9. Dominique Gendrel
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  10. Albert Bensman
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Corresponding author

Correspondence to Sandrine Leroy.

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Leroy, S., Chalumeau, M., Ulinski, T. et al. Impressive renal damage after acute pyelonephritis in a child. Pediatr Nephrol 25, 1365–1368 (2010). https://doi.org/10.1007/s00467-010-1461-x

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  • DOI: https://doi.org/10.1007/s00467-010-1461-x

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