title: Early treatment of acute pyelonephritis in children fails to reduce renal scarring: data from the Italian Renal Infection Study Trials.
abstract: OBJECTIVE
  The American Academy of Pediatrics recommendation for febrile infants and young children suspected of having a urinary tract infection is early antibiotic treatment, given parenterally if necessary. In support of this recommendation, data suggesting that delay in treatment of acute pyelonephritis increases the risk of kidney damage are cited. Because the risk was not well defined, we investigated renal scarring associated with delayed versus early treatment of acute pyelonephritis in children.
  
  
  METHODS
  The research findings are derived from 2 multicenter, prospective, randomized, controlled studies, Italian Renal Infection Study 1 and 2, whose primary outcomes dealt with initial antibiotic treatment and subsequent prophylaxis, respectively. From the 2 studies, we selected the 287 children with confirmed pyelonephritis on acute technetium-99m-dimercaptosuccinic acid scans who underwent repeat scanning to detect scarring 12 months later. The children were 1 month to <7 years of age when they presented with their first recognized episode of acute pyelonephritis in northeast Italy.
  
  
  RESULTS
  Progressive delay in antibiotic treatment of acute pyelonephritis from <1 to >/=5 days after the onset of fever was not associated with any significant increase in the risk of scarring on technetium-99m-dimercaptosuccinic acid scans obtained 1 year later. The risk of scarring remained relatively constant at 30.7 +/- 7%. Clinical and laboratory indices of inflammation were comparable in all groups, as was the incidence of vesicoureteric reflux.
  
  
  CONCLUSIONS
  Early treatment of acute pyelonephritis in infants and young children had no significant effect on the incidence of subsequent renal scarring. Furthermore, there was no significant difference in the rate of scarring after acute pyelonephritis when infants and young children were compared with older children.
authors.affiliation: Nephrology, Dialysis, and Transplant Unit, Pediatric Department, Azienda Ospedaliera di Padova, Via Giustiniani, 3, 35128 Padova, Italy.
authors.forename: Ian K
authors.initials: IK
authors.lastname: Hewitt
authors.forename: Pietro
authors.initials: P
authors.lastname: Zucchetta
authors.forename: Luca
authors.initials: L
authors.lastname: Rigon
authors.forename: Francesca
authors.initials: F
authors.lastname: Maschio
authors.forename: Pier Paolo
authors.initials: PP
authors.lastname: Molinari
authors.forename: Lisanna
authors.initials: L
authors.lastname: Tomasi
authors.forename: Antonella
authors.initials: A
authors.lastname: Toffolo
authors.forename: Luigi
authors.initials: L
authors.lastname: Pavanello
authors.forename: Carlo
authors.initials: C
authors.lastname: Crivellaro
authors.forename: Stefano
authors.initials: S
authors.lastname: Bellato
authors.forename: Giovanni
authors.initials: G
authors.lastname: Montini