Abstract：
OBJECTIVE: This prospective study aimed to evaluate the characteristics and findings of children who presented with acute pyelonephritis (APN) and to determine the independent risk factors for kidney scarring.
METHODS: Patients who satisfied the following criteria were enrolled in the study: first known episode of APN; at least two of the following findings: fever ≥ 38.5 °C, white blood cell count ≥ 10,000/mm3, erythrocyte sedimentation rate ≥ 20 mm/h, C-reactive protein ≥ 20 mg/dL; absence of congenital abnormalities or other kidney and systemic diseases, except vesicoureteral reflux (VUR); no APN relapses until the time of kidney scar detection. 99mTc-Dimercaptosuccinic acid kidney scintigraphy (99mTc-DMSA) was performed at admission, along with a kidney ultrasound. Follow-up 99mTc-DMSA took place after 6 months. Radiographic cystourethrography for VUR detection and grading was performed 1 month after the acute infection.
RESULTS: We enrolled 70 children in the study. The kidney ultrasound failed to diagnose more than half of the cases of APN. VUR was found in 21.5% of children. 75% had findings of APN in the acute phase through 99mTc-DMSA, while in the second 99mTc-DMSA, there was a complete remission in 68% of them. Scars were observed more frequently in older children, children with VUR grade ≥ III, and children not on antibiotic prophylaxis.
CONCLUSIONS: VUR did not appear to be associated with the first episode of APN, and children older than 1 year of age had a higher risk of scarring. Antibiotic prophylaxis may prevent kidney scarring due to host immunomodulatory effects, but more studies are needed so that conclusions can be drawn.
METHODS: Patients who satisfied the following criteria were enrolled in the study: first known episode of APN; at least two of the following findings: fever ≥ 38.5 °C, white blood cell count ≥ 10,000/mm3, erythrocyte sedimentation rate ≥ 20 mm/h, C-reactive protein ≥ 20 mg/dL; absence of congenital abnormalities or other kidney and systemic diseases, except vesicoureteral reflux (VUR); no APN relapses until the time of kidney scar detection. 99mTc-Dimercaptosuccinic acid kidney scintigraphy (99mTc-DMSA) was performed at admission, along with a kidney ultrasound. Follow-up 99mTc-DMSA took place after 6 months. Radiographic cystourethrography for VUR detection and grading was performed 1 month after the acute infection.
RESULTS: We enrolled 70 children in the study. The kidney ultrasound failed to diagnose more than half of the cases of APN. VUR was found in 21.5% of children. 75% had findings of APN in the acute phase through 99mTc-DMSA, while in the second 99mTc-DMSA, there was a complete remission in 68% of them. Scars were observed more frequently in older children, children with VUR grade ≥ III, and children not on antibiotic prophylaxis.
CONCLUSIONS: VUR did not appear to be associated with the first episode of APN, and children older than 1 year of age had a higher risk of scarring. Antibiotic prophylaxis may prevent kidney scarring due to host immunomodulatory effects, but more studies are needed so that conclusions can be drawn.
摘要：
目的：这项前瞻性研究旨在评估急性肾盂肾炎（APN）患儿的特征和表现，并确定肾脏瘢痕形成的独立危险因素。
方法：将符合以下标准的患者纳入研究：首次已知的APN发作；以下发现中的至少两个：发烧≥38.5°C，白细胞计数≥10,000/mm3，红细胞沉降率≥20mm/h，C反应蛋白≥20mg/dL；无先天性异常或其他肾脏和全身性疾病，除膀胱输尿管反流（VUR）外；直到检测到肾脏瘢痕时，APN才复发。入院时进行99mTc-二巯基琥珀酸肾脏闪烁显像（99mTc-DMSA），还有肾脏超声检查.随访6个月后进行99mTc-DMSA。急性感染后1个月进行X线膀胱尿道造影以检测和分级VUR。
结果：我们招募了70名儿童参与研究。肾脏超声未能诊断出超过一半的APN病例。在21.5％的儿童中发现了VUR。75%的人在急性期通过99mTc-DMSA发现APN，而在第二个99mTc-DMSA中，68%的患者完全缓解。在年龄较大的儿童中更频繁地观察到疤痕，VUR等级≥III的儿童，和没有使用抗生素预防的儿童。
结论：VUR似乎与APN的第一集无关，1岁以上的儿童有更高的疤痕风险。抗生素预防可以预防由于宿主免疫调节作用而导致的肾脏疤痕，但是需要更多的研究才能得出结论。
方法：将符合以下标准的患者纳入研究：首次已知的APN发作；以下发现中的至少两个：发烧≥38.5°C，白细胞计数≥10,000/mm3，红细胞沉降率≥20mm/h，C反应蛋白≥20mg/dL；无先天性异常或其他肾脏和全身性疾病，除膀胱输尿管反流（VUR）外；直到检测到肾脏瘢痕时，APN才复发。入院时进行99mTc-二巯基琥珀酸肾脏闪烁显像（99mTc-DMSA），还有肾脏超声检查.随访6个月后进行99mTc-DMSA。急性感染后1个月进行X线膀胱尿道造影以检测和分级VUR。
结果：我们招募了70名儿童参与研究。肾脏超声未能诊断出超过一半的APN病例。在21.5％的儿童中发现了VUR。75%的人在急性期通过99mTc-DMSA发现APN，而在第二个99mTc-DMSA中，68%的患者完全缓解。在年龄较大的儿童中更频繁地观察到疤痕，VUR等级≥III的儿童，和没有使用抗生素预防的儿童。
结论：VUR似乎与APN的第一集无关，1岁以上的儿童有更高的疤痕风险。抗生素预防可以预防由于宿主免疫调节作用而导致的肾脏疤痕，但是需要更多的研究才能得出结论。
