Acute urinary tract infection--evaluation and treatment.
OBJECTIVE
The evaluation and management of urinary tract infections in infants and children is undergoing changes due to the impact of evidence-based studies and new technology.


RESULTS
The uncircumcised male infant is at increased risk for a urinary tract infection, but there is marked difference in the frequency of circumcision carried out to lower the risk of infection in the United States compared with Europe. Commentaries presenting different interpretations of the current data make for interesting reading and present the many sides of this issue. Vesicoureteric reflux, previously viewed as the major risk factor for acquired renal damage, now shares this role with nonreflux nephropathy. Procalcitonin has been evaluated as a biochemical tool to identify patients at risk for kidney damage, with dimercaptosuccinic acid scintigraphy as the reference method to detect renal scarring.


CONCLUSIONS
The previously accepted concept that vesicoureteric reflux as detected radiologically is almost always the key factor in acquired renal injury secondary to a urinary tract infection is no longer accepted. Current studies show that nonreflux nephropathy occurs as often as reflux nephropathy. There is now a question of the value of imaging studies designed to identify vesicoureteric reflux and of the use of suppressive antibiotics for vesicoureteric reflux. There exist useful evidence-based studies for antibiotic therapy for upper and lower tract urinary tract infections, but no such data are available for guidance in selecting imaging studies for the infant or child with a first febrile urinary tract infection.
Hellerstein
Stanley
S
Section of Pediatric Nephrology, The Children's Mercy Hospital, The University of Missouri School of Medicine at Kansas City, Missouri 64108, USA. shellers@cmh.edu
D000208:Acute Disease; D002116:Calcitonin / Q000627:therapeutic use; D015740:Calcitonin Gene-Related Peptide; D002648:Child; D002944:Circumcision, Male; D005260:Female; D005334:Fever / Q000209:etiology; D006023:Glycoproteins / Q000627:therapeutic use; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging; D008297:Male; D011498:Protein Precursors / Q000627:therapeutic use; D012307:Risk Factors; D014463:Ultrasonography; D014552:Urinary Tract Infections / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy*; D014718:Vesico-Ureteral Reflux / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology
C000606589:CALCA protein, human; D006023:Glycoproteins; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide