Abstract
Background
The treatment of complicated urinary tract infection in children is still a matter of debate. In our hospital, antimicrobial treatment is initiated intravenously, and the duration of this treatment is adapted according to the results of a Tc-99m dimercaptosuccinic acid (DMSA) scintigraphy.
Aim
This study was conducted to evaluate retrospectively the frequency and the importance of late renal sequelae when treating intravenously for 7 days those patients with an abnormal acute DMSA.
Methods
A review was conducted of the medical charts of all patients consecutively admitted between 2005 and 2008 with positive urine culture and clinical and biological evidence of complicated urinary tract infection (UTI).
Results
There were 144 patients (59 %) with abnormal early DMSA scintigraphy and 98 (41 %) with normal scintigraphy. The median duration of intravenous treatment was 7.0 days in the children with DMSA lesions and 5.0 days in those without lesions. Obvious renal sequelae were observed on late DMSA scintigraphy in 4 (6 %) out of the 65 patients with an abnormal early DMSA who came back for control scintigraphy.
Conclusion
Sequelae of acute DMSA lesions observed during complicated UTI treated 7 days intravenously were infrequent. Whether the mode and duration of antimicrobial treatment might explain the low rate of sequelae remains to be demonstrated.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
American Academy of Pediatrics, Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management (2011) Diagnosis and management of initial UTIs in febrile infants and children aged 2 to 24 months. Pediatrics 128:595–610
Benador D, Neuhaus TJ, Papazyan JP, Willi UV, Engel-Bicik I, Nadal D, Slosman D, Mermillod B, Girardin E (2001) Randomised controlled trial of three day versus 10 day intravenous antibiotics in acute pyelonephritis: effect on renal scarring. Arch Dis Child 84:241–246
Bocquet N, Sergent A, Jais JP, Gajdos V, Guigonis V, Lacour B, Chéron G (2012) Randomized trial of oral versus sequential IV/oral antibiotic for acute pyelonephritis in children. Pediatrics 129:e269–e275
Bouissou F, Munzer C, Decramer S, Roussel B, Novo R, Morin D, Lavocat MP, Guyot C, Taque S, Fischbach M, Ouhayoun E (2008) Prospective, randomized trial comparing short and long intravenous antibiotic treatment of acute pyelonephritis in children: dimercaptosuccinic acid scintigraphic evaluation at 9 months. Pediatrics 121:553–560
Burns MW, Burns JL, Krieger JN (1987) Pediatric urinary tract infection. Diagnosis, classification and significance. Pediatr Clin N Am 34:111–115
Cornu C, Cochat P, Collet JP, Delair S, Haugh MC, Rolland C (1994) Survey of the attitudes to management of acute pyelonephritis in children. Pediatr Nephrol 8:275–277
Daly MJ, Jones W, Rudd TG, Tremann J (1979) Differential renal function using Tc-99m dimercaptosuccinic acid (DMSA); in vitro correlation. J Nucl Med 20:63–66
Faust WC, Diaz M, Pohl HG (2009) Incidence of post-pyelonephritic renal scarring:a meta-analysis of the dimercapto-succinic acid literature. J Urol 181:290–297
Hansson S, Jodal U (1999) Urinary tract infection. In: Barratt TM, Avner ED, Harmon WE (eds) Pediatric nephrology, 4th edn. Lippincot Williams and Wilkins, Baltimore
Hansson S, Dhamey M, Sigstrom O, Sixt R, Stokland E, Wennerström M, Jodal U (2004) Dimercapto-succinic acid scintigraphy instead of voiding cystourethrography for infants with urinary tract infection. J Urol 172:1071–1073
Hoberman A, Wald ER, Hickey RW, Baskin M, Charron M, Majd M, Kearney DH, Reynolds EA, Ruley J, Janosky JE (1999) Oral versus initial intravenous therapy for urinary tract infections in young febrile children. Pediatrics 104:79–86
Keren R, Chan E, Hodson E, Michael M, Craig J, Martin S, Moye V (2003) Short versus standard duration antibiotic treatment for UTIs: a comparison of two meta-analyses. Arch Dis Child 88:89–91
Levtchenko EN, Ham HR, Lévy J, Piepsz A (2001) Attitude of Belgian pediatricians toward strategy in acute pyelonephritis. Pediatr Nephrol 16:113–115
Levtchenko EN, Lahy C, Levy J, Ham H, Piepsz A (2001) Treatment of children with acute pyelonephritis: a prospective randomized study. Pediatr Nephrol 16:878–884
Montini G, Toffolo A, Zucchetta P, Dall'Amico R, Gobber D, Calderan A, Maschio F, Pavanello L, Molinari PP, Scorrano D, Zanchetta S, Cassar W, Brisotto P, Corsini A, Sartori S, Da Dalt L, Murer L, Zacchello G (2007) Antibiotic treatment for pyelonephritis in children: multicentre randomised controlled non-inferiority trial. BMJ 25:335–386
Mori R, Lakhanpaul M, Verrier-Jones K (2007) Diagnosis and management of urinary tract infection in children: summary of NICE guidance. Br Med J 335:395–397
Piepsz A, Colarinha P, Gordon I, Hahn K, Olivier P, Roca I, Sixt R, van Velzen J, Paediatric Committee of the European Association of Nuclear Medicine (2001) Guidelines for 99mTc-DMSA scintigraphy in children. Eur J Nucl Med 28:BP37–BP41
Piepsz A, Ham HR (2005) Pediatric applications of renal nuclear medicine. Semin Nucl Med 1:16–35
Preda I, Jodal U, Sixt R, Stokland E, Hansson S (2007) Normal dimercaptosuccinic acid scintigraphy makes voiding cystourethrography unnecessary after urinary tract infection. J Pediatr 151:581–584
Shaikh N, Ewing AL, Bhatnagar S, Hoberman A (2010) A risk of renal scarring in children with a first urinary tract infection: a systematic review. Pediatrics 126:1084–1091
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ferreiro, C., Piepsz, A., Nogarède, C. et al. Late renal sequelae in intravenously treated complicated urinary tract infection. Eur J Pediatr 172, 1243–1248 (2013). https://doi.org/10.1007/s00431-013-2024-5
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00431-013-2024-5