Objective To assess factors associated with renal scarring in children with urinary tract infections.
Design Prospective study.
Method Tc 99 DMSA scan was done to detect renal scars in 290 children below the age of 12 years with a proven urinary tract infection. They were also screened to detect underlying abnormalities by ultrasonography, micturating cystourethrogram (MCUG), Tc DTPA scan and intravenous pyelography (IVP) when indicated.
Results Out of the 290 children studied 114 (39%) had detectable renal scars on Tc 99 DMSA scan. 59 (52%) of them were males and 55 (48%) were females. Right kidney was affected in 36 (31%) patients and left kidney was affected in 56 (49%) patients and both kidneys were affected in 22 (19%) patients. Multiple renal scars involving both kidneys were detected in 8 patients.
Of the 114 patients with renal scarring, 105 (92%) patients presented to us with the first episode of urinary tract infection. Out of the nine patients who presented with recurrent attacks, 8 showed multiple scarring of both kidneys. Specific urinary symptoms was the presenting feature in 75 (66%) of patients with renal scars and 39 (35%) presented with non specific symptoms.
Underlying urinary tract abnormalities were detected in 48 (42%) of patients with renal scaring and the main abnormality detected was the vesico-ureteric reflux in 36/48 (73%) of patients. E. coli, sensitive to most of the commonly used antibiotics, was the commonest organism identified in 99% of patients.
Conclusions Rate of scarring of kidneys in proven urinary tract infections is similar to studies done in other countries. Recurrent episodes resulted in multiple scarring of kidneys.