title: Does prompt treatment of urinary tract infection in preschool children prevent renal scarring: mixed retrospective and prospective audits.
abstract: OBJECTIVE
  To test whether active management of urinary tract infections (UTI) in young children by general practitioners can reduce kidney scarring rates.
  
  
  METHODS
  A comparison of two audits in Newcastle, of children aged <8 years, presenting with UTIs ; a retrospective audit of conventional management during 1992-1995 (1990s) versus a prospective audit of direct access management during 2004-2011 (2000s).
  
  
  METHODS
  Kidney scarring rates, and their relationship with time-to-treat.
  
  
  RESULTS
  Children with a first UTI in the 2000s compared to those in the 1990s, were referred younger, were half as likely to have a renal scar (girls OR 0.47, 95% CI 0.29 to 0.76; boys 0.35, 0.16 to 0.81), and were about 12 times more likely to have vesicoureteric reflux without scarring (girls 11.9, 4.3 to 33.5; boys 14.4, 4.3 to 47.6). In the 2000s, general practitioners treated about half the children at first consultation. Children who were treated within 3 days of their symptoms starting were one-third as likely to scar as those whose symptoms lasted longer (0.33, 0.12 to 0.72).
  
  
  CONCLUSIONS
  Most kidney defects seen in children after UTIs, are acquired scars, and in Newcastle, active management in primary care has halved this rate.
authors.affiliation: Paediatric Nephrology Unit, Great North Children's Hospital, , Newcastle, UK.
authors.forename: Malcolm G
authors.initials: MG
authors.lastname: Coulthard
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Lambert
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Vernon
authors.forename: Elizabeth W
authors.initials: EW
authors.lastname: Hunter
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Keir
authors.forename: John N S
authors.initials: JN
authors.lastname: Matthews
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002921:Cicatrix / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D004334:Drug Administration Schedule; D004739:England / Q000453:epidemiology; D005194:Family Practice / Q000379:methods; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007674:Kidney Diseases / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D008297:Male; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D055502:Secondary Prevention / Q000379:methods; D012720:Severity of Illness Index; D017678:Sex Distribution; D014552:Urinary Tract Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D014718:Vesico-Ureteral Reflux / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control
chemical_list: D000900:Anti-Bacterial Agents
keywords: prompt treatment; renal scarring; urinary tract infection; vesicoureteric reflux