[Follow-up and prognosis of pyelonephritis in infancy].
128 infants between 1 and 18 months, 80 girls and 48 boys suffering from their first pyelonephritis (PN), were investigated and followed up over 2.9 +/- 2.2 years (mean +/- SD). 20 children showed urinary tract obstructions. In 49 of 108 cases (45%) with nonobstructive PN a vesico-uretero-renal reflux (VUR) was found and surgically corrected in 13 cases. In 36 patients (52 renal units) the VUR disappeared in most cases under medical management within 3 years. Recurrences of urinary tract infections (UTI) were found in the same frequency in children with and without reflux (28%), but those with VUR showed significantly more PN. 22 of 108 patients with nonobstructive PN (20%) developed renal scars, 39% of children with reflux (mostly VUR III. or IV. degree), 5% of those without reflux. In more than half of these cases renal scars were found already after the first PN. We conclude that a reduction of the risk of renal damage and an improvement of the prognosis can achieved by the following measures: 1. early detection of obstruction by pre- or postnatal sonographic screening, 2. early and exact diagnosis of PN and antibiotic therapy without delay. PN has to be excluded in all infants with unclear fever. 3. In all infants with PN a voiding cystography should be performed. In children with VUR, long-term chemoprophylaxis is necessary to avoid recurrence of PN.
Misselwitz
J
J
Klinik für Kinder- und Jugendmedizin Jussuf Ibrahim des Klinikums, Friedrich-Schiller-Universität Jena.
John
U
U
Vogt
S
S
D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D011379:Prognosis; D011704:Pyelonephritis / Q000175:diagnosis / Q000209:etiology*; D012008:Recurrence; D012307:Risk Factors; D014463:Ultrasonography; D014567:Urography
Verlauf und Prognose der Pyelonephritis im Säuglingsalter.