Predictive factors for acute renal cortical scintigraphic lesion and ultimate scar formation in children with first febrile urinary tract infection.
OBJECTIVE
We assessed predictive factors for acute renal cortical scintigraphic lesion and ultimate scar formation in children with a first febrile urinary tract infection.


METHODS
A total of 89 girls and 138 boys with a first febrile urinary tract infection were included in the study. We analyzed radiological (ultrasound, dimercapto-succinic acid scintigraphy, voiding cystourethrogram), clinical (age, gender, peak fever, therapeutic delay time) and laboratory (complete blood count with differential count, absolute neutrophil count, blood urea nitrogen, creatinine, urinalysis, Gram's stain, culture, C-reactive protein, erythrocyte sedimentation rate) variables. Dimercapto-succinic acid scintigraphy was performed within 5 days and at 6 months after diagnosis of urinary tract infection. Voiding cystourethrogram was performed after the acute phase of the urinary tract infection. Predictive factors for acute scintigraphic lesion and ultimate scar formation were assessed using logistic regression analysis.


RESULTS
Of 227 patients enrolled 140 had a refluxing and 87 a nonrefluxing urinary tract infection. On logistic regression analysis therapeutic delay time (p = 0.001) and presence of reflux (p = 0.011) were predictive of acute scintigraphic lesion and ultimate scar formation (p = 0.001 and p = 0.0001, respectively) in children with a first febrile urinary tract infection.


CONCLUSIONS
Since vesicoureteral reflux is the common risk factor for acute scintigraphic lesion and ultimate scar formation, voiding cystourethrogram must be considered as an initial study in patients with acute febrile urinary tract infection.
Oh
Mi Mi
MM
Department of Urology, Korea University Medical Center, Seoul, Korea.
Cheon
Jun
J
Kang
Seok Ho
SH
Park
Hong Seok
HS
Lee
Jeong Gu
JG
Moon
Du Geon
du G
D000208:Acute Disease; D002648:Child; D002921:Cicatrix / Q000209:etiology*; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D007672:Kidney Cortex / Q000293:injuries*; D007674:Kidney Diseases / Q000209:etiology*; D008297:Male; D011379:Prognosis; D011877:Radionuclide Imaging / Q000009:adverse effects; D012307:Risk Factors; D014552:Urinary Tract Infections / Q000150:complications / Q000000981:diagnostic imaging*