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Korean J Pediatr 2012 October;55(10) :367-370.
Published online 2012 July 25.        doi:
Renal scar formation after urinary tract infection in children
Young Seo Park (Park YS)
Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Corresponding Author: Young Seo Park ,Tel: +82-2-3010-3376, Fax: +82-2-473-3725, Email:
Copyright © 2012 by The Korean Pediatric Society
Urinary tract infection (UTI) is a common bacterial illness in children. Acute pyelonephritis in children may lead to renal scarring with the risk of later hypertension, preeclampsia during pregnancy, proteinuria, and renal insufficiency. Until now, vesicoureteral reflux (VUR) has been considered the most important risk factor for post-UTI renal scar formation in children. VUR predisposes children with UTI to pyelonephritis, and both are associated with renal scarring. However, reflux nephropathy is not always acquired; rather, it reflects refluxassociated congenital dysplastic kidneys. The viewpoint that chronic kidney disease results from renal maldevelopment-associated VUR has led to questioning the utility of any regimen directed at identifying or treating VUR. Despite the recognition that underlying renal anomalies may be the cause of renal scarring that was previously attributed to infection, the prevention of renal scarring remains the goal of all therapies for childhood UTI. Therefore, children at high risk of renal scar formation after UTI should be treated and investigated until a large clinical study and basic research give us more information.
Keywords: Urinary tract infection | Renal scar | Vesico-ureteral reflux | Child
1. Peters C, Rushton HG. Vesicoureteral reflux associated renal damage: congenital reflux nephropathy and acquired renal scarring. J Urol 2010;184:265–273.
2. Faust WC, Diaz M, Pohl HG. Incidence of post-pyelonephritic renal scarring: a meta-analysis of the dimercapto-succinic acid literature. J Urol 2009;181:290–297.
3. Shaikh N, Ewing AL, Bhatnagar S, Hoberman A. Risk of renal scarring in children with a first urinary tract infection: a systematic review. Pediatrics 2010;126:1084–1091.
4. Lee YJ, Lee JH, Park YS. Risk factors for renal scar formation in infants with first episode of acute pyelonephritis: a prospective clinical study. J Urol 2012;187:1032–1036.
5. Orellana P, Baquedano P, Rangarajan V, Zhao JH, Eng ND, Fettich J, et al. Relationship between acute pyelonephritis, renal scarring, and vesicoureteral reflux: results of a coordinated research project. Pediatr Nephrol 2004;19:1122–1126.
6. Pecile P, Miorin E, Romanello C, Vidal E, Contardo M, Valent F, et al. Age-related renal parenchymal lesions in children with first febrile urinary tract infections. Pediatrics 2009;124:23–29.
7. Jahnukainen T, Chen M, Celsi G. Mechanisms of renal damage owing to infection. Pediatr Nephrol 2005;20:1043–1053.
8. Wullt B, Bergsten G, Fischer H, Godaly G, Karpman D, Leijonhufvud I, et al. The host response to urinary tract infection. Infect Dis Clin North Am 2003;17:279–301.
9. Lee JH, Son CH, Lee MS, Park YS. Vesicoureteral reflux increases the risk of renal scars: a study of unilateral reflux. Pediatr Nephrol 2006;21:1281–1284.
10. Soylu A, Demir BK, Turkmen M, Bekem O, Saygi M, Cakmakci H, et al. Predictors of renal scar in children with urinary infection and vesicoureteral reflux. Pediatr Nephrol 2008;23:2227–2232.
11. Zaffanello M, Cataldi L, Brugnara M, Franchini M, Bruno C, Fanos V. Hidden high-grade vesicoureteral reflux is the main risk factor for chronic renal damage in children under the age of two years with first urinary tract infection. Scand J Urol Nephrol 2009;43:494–500.
12. Roberts JA. Etiology and pathophysiology of pyelonephritis. Am J Kidney Dis 1991;17:1–9.
13. Cotran RS. Nephrology Forum. Glomerulosclerosis in reflux nephropathy. Kidney Int 1982;21:528–534.
14. Smellie JM, Prescod NP, Shaw PJ, Risdon RA, Bryant TN. Childhood reflux and urinary infection: a follow-up of 10-41 years in 226 adults. Pediatr Nephrol 1998;12:727–736.
15. Williams G, Fletcher JT, Alexander SI, Craig JC. Vesicoureteral reflux. J Am Soc Nephrol 2008;19:847–862.
16. Ichikawa I, Kuwayama F, Pope JC 4th, Stephens FD, Miyazaki Y. Paradigm shift from classic anatomic theories to contemporary cell biological views of CAKUT. Kidney Int 2002;61:889–898.
17. Garin EH, Olavarria F, Garcia Nieto V, Valenciano B, Campos A, Young L. Clinical significance of primary vesicoureteral reflux and urinary antibiotic prophylaxis after acute pyelonephritis: a multicenter, randomized, controlled study. Pediatrics 2006;117:626–632.
18. Roussey-Kesler G, Gadjos V, Idres N, Horen B, Ichay L, Leclair MD, et al. Antibiotic prophylaxis for the prevention of recurrent urinary tract infection in children with low grade vesicoureteral reflux: results from a prospective randomized study. J Urol 2008;179:674–679.
19. Marks SD, Gordon I, Tullus K. Imaging in childhood urinary tract infections: time to reduce investigations. Pediatr Nephrol 2008;23:9–17.
20. National Institute for health and Clinical ExcellenceUrinary tract infection in children (CG54) [Internet]. London: National Institute for health and Clinical Excellence; c2012 [cited 2012 May 17].
21. Jodal U, Lindberg U. Swedish Medical Research Council. Guidelines for management of children with urinary tract infection and vesico-ureteric reflux: recommendations from a Swedish state-of-the-art conference. Acta Paediatr Suppl 1999;88:87–89.
22. Newman TB. The new American Academy of Pediatrics urinary tract infection guideline. Pediatrics 2011;128:572–575.
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