title: Delayed treatment of the first febrile urinary tract infection in early childhood increased the risk of renal scarring.
abstract: OBJECTIVE
  This study evaluated the controversial relationship between the duration of fever before treatment initiation (FBT) for a febrile urinary tract infection (UTI), with renal scarring based on dimercaptosuccinic acid scintigraphy (DMSA) findings.
  
  
  METHODS
  The inpatient records of 148 children under two years of age with a first episode of febrile UTI were analysed. Acute and repeat DMSA findings, and clinical and laboratory parameters were evaluated.
  
  
  RESULTS
  Acute DMSA showed that 76 of the 148 children with a febrile UTI had renal lesions: 20 were mild, and 56 were moderate or severe. Repeat DMSA showed renal scarring in 34 patients. The only factors associated with the development of renal scars in the repeat DMSA were FBT of more than 72 hours, the presence and severity of vesicoureteral reflux and increased procalcitonin levels and absolute neutrophil counts. Multiple regression analysis showed that an FBT above 72 hours was the only significant factor that predicted renal scars.
  
  
  CONCLUSIONS
  Delay in treatment initiation of 72 hours or more was a risk factor for permanent renal scars after the first episode of febrile UTI. Other associated factors were increased procalcitonin and absolute neutrophil count on admission and the presence and severity of vesicouretal reflux.
authors.affiliation: Second Department of Pediatrics, National and Kapodistrian University of Athens, "P. and A. Kyriakou" Children's Hospital, Athens, Greece.
authors.forename: Kyriaki A
authors.initials: KA
authors.lastname: Karavanaki
authors.affiliation: Second Department of Pediatrics, National and Kapodistrian University of Athens, "P. and A. Kyriakou" Children's Hospital, Athens, Greece.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Soldatou
authors.affiliation: Second Department of Pediatrics, National and Kapodistrian University of Athens, "P. and A. Kyriakou" Children's Hospital, Athens, Greece.
authors.forename: Athina Maria
authors.initials: AM
authors.lastname: Koufadaki
authors.affiliation: Second Department of Pediatrics, National and Kapodistrian University of Athens, "P. and A. Kyriakou" Children's Hospital, Athens, Greece.
authors.forename: Charalampos
authors.initials: C
authors.lastname: Tsentidis
authors.affiliation: Second Department of Pediatrics, "Aghia Sophia" Children's Hospital, Athens, Greece.
authors.forename: Fotis A
authors.initials: FA
authors.lastname: Haliotis
authors.affiliation: Department of Pediatric Nephrology, "P. and A. Kyriakou" Children's Hospital, Athens, Greece.
authors.forename: Constantinos J
authors.initials: CJ
authors.lastname: Stefanidis
mesh_terms: D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002675:Child, Preschool; D002921:Cicatrix / Q000000981:diagnostic imaging / Q000209:etiology*; D004334:Drug Administration Schedule; D005260:Female; D005334:Fever / Q000209:etiology*; D005500:Follow-Up Studies; D016905:Gram-Negative Bacterial Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007668:Kidney / Q000000981:diagnostic imaging / Q000473:pathology*; D016015:Logistic Models; D008297:Male; D011704:Pyelonephritis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D013997:Time Factors; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology
chemical_list: D000900:Anti-Bacterial Agents; D019275:Radiopharmaceuticals; D019783:Technetium Tc 99m Dimercaptosuccinic Acid
keywords: Acute pyelonephritis; Dimercaptosuccinic acid scintigraphy; Indices of infection; Prolonged fever; Vesicoureteral reflux