Acute lobar nephronia is associated with a high incidence of renal scarring in childhood urinary tract infections.
BACKGROUND
Acute lobar nephronia (ALN) is a severe nonliquefactive inflammatory renal bacterial infection, and requires a longer duration of treatment. The aim of this prospective study was to investigate renal scarring after ALN and to examine the risk factors for renal scarring in children with ALN compared with those with acute pyelonephritis (APN).


METHODS
Patients with computed tomography-diagnosed ALN were enrolled and randomly allocated, with serial entry, to either a 2- or 3-week antibiotic treatment regimen. Age- and gender-matched APN patients served as comparators. Patients underwent dimercaptosuccinic acid scintigraphy at least 6 months later to assess renal scarring.


RESULTS
A total of 218 children (109 ALN, 109 APN) were enrolled. The incidence of renal scarring was similar between 2- and 3-week treatment groups and was higher in ALN patients than in APN patients (89.0% vs. 34.9%, P < 0.001). Renal scarring was prone to occur in children with higher inflammatory indices and longer duration of fever before and after treatment. Multiple regression analysis on independent variables showed that only ALN was significantly associated with a higher incidence of renal scarring.


CONCLUSIONS
Our results showed a new finding that ALN is associated with a very high incidence of renal scarring, in comparison to APN, irrespective of the duration of antibiotic treatment.
Department of Pediatrics, Chang Gung Children's Hospital, Taoyuan, Taiwan.
Chi-Hui
CH
Cheng
Yong-Kwei
YK
Tsau
Chee-Jen
CJ
Chang
Yu-Chen
YC
Chang
Chen-Yen
CY
Kuo
I-Jung
IJ
Tsai
Yi-Hsien
YH
Hsu
Tzou-Yien
TY
Lin
D001424:Bacterial Infections / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D002921:Cicatrix / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007668:Kidney / Q000473:pathology*; D008297:Male; D011446:Prospective Studies; D011704:Pyelonephritis / Q000150:complications*; D012307:Risk Factors; D014552:Urinary Tract Infections / Q000150:complications*