Bacterial virulence factors are associated with occurrence of acute pyelonephritis but not renal scarring.
OBJECTIVE
We evaluated the influence of patient factors and virulence factors of uropathogenic Escherichia coli on the occurrence of acute pyelonephritis and subsequent renal parenchymal scarring.


METHODS
We evaluated 80 boys and 45 girls 1 to 180 months old with febrile urinary tract infections who underwent renal scan to diagnose acute pyelonephritis and followup dimercapto-succinic acid scintigraphy at least 6 months later. Urinalysis, white blood cell count, uropathogenic E. coli genotype and vesicoureteral reflux were measured. Voiding cystourethrogram was investigated after acute pyelonephritis was confirmed by renal scan and acute inflammation subsided, about 2 to 4 weeks later.


RESULTS
Acute pyelonephritis was significantly more likely to develop in children with urinary tract infections and persistent fever before and after hospitalization, elevated C-reactive protein or positive renal ultrasound findings. E. coli strains with the papG II and iha genes were significantly more likely to occur in patients with acute pyelonephritis. Patients with a fever for more than 3 days and C-reactive protein levels greater than 90.8 mg/l were significantly more likely to have renal scarring. Age was not an independent predictor of acute pyelonephritis, but modified the effect of virulence factors on the development of acute pyelonephritis.


CONCLUSIONS
Bacterial virulence factors and host factors are associated with the occurrence of acute pyelonephritis. Host factors such as patient age and vesicoureteral reflux severity modify the influence of virulence factors, although only host factors are associated with the occurrence of renal scarring.
Chiou
Yuan-Yow
YY
Department of Pediatrics and Institute of Clinical Medicine, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan.
Chen
Mei-Ju
MJ
Chiu
Nan-Tsing
NT
Lin
Ching-Yuang
CY
Tseng
Chin-Chung
CC
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002921:Cicatrix; D004927:Escherichia coli Infections; D005260:Female; D006801:Humans; D007223:Infant; D007674:Kidney Diseases; D008297:Male; D011704:Pyelonephritis / Q000382:microbiology*; D014552:Urinary Tract Infections / Q000382:microbiology*; D056689:Uropathogenic Escherichia coli / Q000472:pathogenicity*; D037521:Virulence Factors
D037521:Virulence Factors