Impressive renal damage after acute pyelonephritis in a child.
Urinary tract infection (UTI) is one of the most common bacterial infections in children, and its role in the pathogenesis of scarred kidney is debated. We report on a 7-year-old child who presented with severe UTI. The early (day 4) renal computed tomography (CT) scan showed normal-sized kidneys (110 mm on the left, 105 mm on the right), whereas the control CT scan and dimercaptosuccinic acid (DMSA) scan, performed 1 and 2 months later, respectively, showed a small scarred right kidney (60 mm) with a 12% residual function. An intermittent right vesicoureteral reflux (VUR) was diagnosed by direct isotopic cystography and then treated by Cohen vesicoureteral reimplantation. The patient remained free of infectious recurrence, hypertension, or renal function decrease. This report demonstrates that one episode of acute pyelonephritis can lead to severe renal scarring. Whereas antenatal lesions are thought to have a stronger role in the causal pathway for reflux nephropathy than is UTI in addition to VUR, this observation reminds us that UTI can truly play an important role in damaging kidneys.
Department of Pediatric Nephrology, Armand Trousseau Hospital, AP-HP, Pierre et Marie Curie University, Paris, France. Sandrine.Leroy@csm.ox.ac.uk
Sandrine
S
Leroy
Martin
M
Chalumeau
Tim
T
Ulinski
François
F
Dubos
Aline
A
Sergent-Alaoui
Valérie
V
Merzoug
Hubert
H
Ducou-le-Pointe
Georges
G
Audry
Dominique
D
Gendrel
Albert
A
Bensman
D000208:Acute Disease; D002648:Child; D002921:Cicatrix / Q000209:etiology / Q000473:pathology*; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D011704:Pyelonephritis / Q000150:complications / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000150:complications / Q000473:pathology*; D014718:Vesico-Ureteral Reflux / Q000209:etiology / Q000473:pathology / Q000601:surgery