title: [Renal scarring in children under 36 months hospitalised for acute pyelonephritis].
abstract: BACKGROUND
  Acute pyelonephritis (APN) is one of the most common causes of serious bacterial infection in infants. Renal scarring is the most prevalent long-term complication.
  
  
  OBJECTIVE
  To review the incidence of renal scarring within 6 months after an episode of APN in children under 36 months and its relationship with imaging studies, clinical settings, and bacteriology.
  
  
  METHODS
  A retrospective study of previously healthy patients aged one to 36 months, admitted for a first episode of APN, with a minimum follow-up of 6 months. Demographic and clinical variables were collected along with bacteriology, renal and bladder ultrasound scan, voiding cystourethrography, DMSA-scintigraphy, and re-infection events.
  
  
  RESULTS
  A total of 125 patients were included in the study, of which 60% were male, the large majority (92%) febrile, and due to E. coli (74.6%). There was a history of prenatal ultrasound scan changes in 15.4%. Ultrasound scan found dilation of the urinary tract in 22.1%. Voiding cystourethrography was performed on 70 patients: 54.3% no abnormalities, 12.8% vesicoureteral reflux (VUR) grade i-iii, and 32.9% iv-v grade VUR. Six patients had iv-v grade VUR with a normal ultrasound scan. Adherence to DMSA-scintigraphy at 6 months was only 61% of that indicated. Renal scarring was found in 44.3% of those in which it was performed (60 cases).
  
  
  CONCLUSIONS
  Almost half (44%) DMSA-scintigraphy in children aged one to 36 months hospitalised for APN show renal scarring at 6 months, which was found to be associated with the re-infection events and the iv-v grade VUR. There was no relationship between scarring and the bacteriology or the elevations of inflammatory biochemical markers.
authors.affiliation: Unidad de Gestión Clínica de Pediatría, Hospital Materno-Infantil, Hospital Regional Universitario de Málaga, Málaga, España.
authors.forename: Begoña
authors.initials: B
authors.lastname: Rodríguez Azor
authors.affiliation: Sección de Lactantes, Unidad de Gestión Clínica de Pediatría, Hospital Materno-Infantil, Hospital Regional Universitario de Málaga; Grupo de Investigación IBIMA, Málaga, España. Electronic address: dr.jmramos@gmail.com.
authors.forename: José Miguel
authors.initials: JM
authors.lastname: Ramos Fernández
authors.affiliation: Unidad de Gestión Clínica de Pediatría, Hospital Materno-Infantil, Hospital Regional Universitario de Málaga, Málaga, España.
authors.forename: Sonia
authors.initials: S
authors.lastname: Sánchiz Cárdenas
authors.affiliation: Sección de Lactantes, Unidad de Gestión Clínica de Pediatría, Hospital Materno-Infantil, Hospital Regional Universitario de Málaga.
authors.forename: Ana
authors.initials: A
authors.lastname: Cordón Martínez
authors.affiliation: Sección de Infectología, Unidad de Gestión Clínica de Pediatría, Hospital Regional Universitario Materno-Infantil, Málaga, España.
authors.forename: Begoña
authors.initials: B
authors.lastname: Carazo Gallego
authors.affiliation: Grupo de Investigación IBIMA, Málaga, España; Departamento de Pediatría y Farmacología, Facultad de Medicina, Universidad de Málaga, Málaga, España; Sección de Infectología, Unidad de Gestión Clínica de Pediatría, Hospital Regional Universitario Materno-Infantil, Málaga, España.
authors.forename: David
authors.initials: D
authors.lastname: Moreno-Pérez
authors.affiliation: Unidad de Gestión Clínica de Pediatría, Hospital Materno-Infantil, Hospital Regional Universitario de Málaga, Málaga, España.
authors.forename: Antonio
authors.initials: A
authors.lastname: Urda Cardona
mesh_terms: D000208:Acute Disease; D002675:Child, Preschool; D002921:Cicatrix / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D011704:Pyelonephritis / Q000150:complications*; D012189:Retrospective Studies
keywords: Cicatriz renal; Cistourografía miccional seriada; DMSA-scintigraphy; Gammagrafía DMSA; Pielonefritis; Pyelonephritis; Renal scar; Voiding cystourethrography