Scarring In Children Research Articles

Risk of Renal Scarring in Children With a First Urinary Tract Infection: A Systematic Review

Risk of Renal Scarring in Children With a First Urinary Tract Infection: A Systematic Review

Five Days of Magic at Asia's Camp for Burn Patients in Taiwan

Five Days of Magic at Asia's Camp for Burn Patients in Taiwan

Related factors with permanent scar in children with urinary tract infections.

زمینه و اهداف : عفونت ادراری یکی از شایعترین بیماری های دوران کودکی مي‌باشد که درصورت عدم تشخیص و درمان به موقع مي‌تواند منجر به عوارض شدیدی نظیر اسکارکلیه شود. شناسایی سریع و درمان به موقع و جدی برای پیشگیری از ایجاد این عارضه لازم است. هدف از این مطالعه بررسی وجود اسکار دائمی کلیه درکودکان مبتلا به عفونت ادراری مي‌باشد. مواد و روش کار : این مطالعه مقطعی بر روی 50 کودک 37 روزه تا 15 ساله مبتلا به عفونت ادراری انجام شد. روش نمونه گیری غیراحتمالی قضاوتی یا مبتنی بر هدف بود. در تمامی کودکان تشخیص عامل ميکروبي زمينه ساز، سونوگرافی ازکلیه ها و سیستم ادراری و سیستویورتروگرام پس از وجود یک کشت منفی ادرار و اسکن دایمرکاپتوسوکسینیک اسید 6 ماه پس از تشخیص عفونت ادراری جهت بررسی اسکار کلیه صورت گرفت. یافته ها : 9 نفر از بیماران پسر و41 نفر دختر و در کل تعداد 22 بیمار دارای اسکار کلیه بودند. شیوع تب درکل بیماران66 درصد بود. عامل عفونت ادراری در 84 درصد موارد ایکولای و میکروب عامل عود نیز در9/71درصد موارد اشریشیاکولی بود. شیوع ریفلاکس درکل بیماران 6/55 درصد و شیوع ریفلاکس اتساعی (درجه III و بالاتر) 4/44 درصد گزارش شد. متوسط تعداد دفعات عود Uniary Tract Infectionدر گروه دارای اسکار 9/3 و در گروه فاقد اسکار 93/1 بود. در نهایت ارتباط میان جنس پسر، عوامل میکروبی غیر معمول (غیر ایکولای) در عود UTI، وجود ریفلاکس ادراری، ریفلاکس اتساعی و تعداد دفعات عود با اسکار کلیه از نظر آماری تأیید گردید (05/0 .( P < نتیجه گیری : برای پیشگیری از اسکار کلیه شناسایی فاکتورهاي مرتبط ضروری است. این مطالعه جنس مذکر، عوامل میکروبی غیر اشریشیاکولی، وجود ریفلاکس ادراری، ریفلاکس درجه III و بالاتر و تعداد دفعات عود UTI از عوامل مرتبط اسکار کلیه مي‌باشند. واژه هاي کليدي: عفونت ادراری، ریفلاکس ادراری، عوامل مرتبط، اسکارکلیه، اطفال

Nephromegaly is a Significant Risk Factor for Renal Scarring in Children With First Febrile Urinary Tract Infections

We determined whether nephromegaly on ultrasound can be used to identify patients with urinary tract infection at increased risk for renal scarring, and we investigated the effect of vesicoureteral reflux on renal scarring. We enrolled hospitalized patients with a first febrile urinary tract infection. All patients underwent renal ultrasound and most patients underwent voiding cystourethrography. Renal scarring was assessed using (99m)technetium dimercapto-succinic acid renal scintigraphy at least 6 months after treatment. Children with recurrent urinary tract infections before scintigraphy were excluded from the study. A total of 545 children (80 with and 465 without nephromegaly) were enrolled. Infection was more severe in patients with than without nephromegaly. The incidence of renal scarring was significantly higher in patients with nephromegaly (90% vs 32%, p <0.001), in kidneys with nephromegaly (80.5% vs 18.7%, p <0.001) and in kidneys with vesicoureteral reflux (41.5% vs 22.2%, p <0.001). Kidneys with nephromegaly had a greater incidence of reflux. The finding of nephromegaly is associated with a greatly increased likelihood of renal scarring in patients with vesicoureteral reflux. Our results indicate that ultrasound diagnosis of nephromegaly at onset is associated with a high incidence of renal scarring, and identification of nephromegaly at onset and vesicoureteral reflux are significant risk factors for renal scarring in children with a first febrile urinary tract infection. Nephromegaly is associated with an increased frequency of vesicoureteral reflux and increased likelihood of renal scarring in patients with reflux.

Novel management of urinary tract infections

To highlight observations that have suggested the need for changing the conventional approach to the evaluation and management of urinary tract infections (UTIs) and vesicoureteral reflux in children and examine new alternative approaches to prevention of UTI and renal scarring based on research into host-pathogen interaction. Recent studies have questioned the traditional approach of using prophylactic antibiotics to prevent recurrence of UTI and development of renal scarring in children with vesicoureteral reflux. Ongoing research on host-pathogen interactions reveals a promising capability to analyze virulence factors in bacteria causing UTIs in children, identify highly virulent bacteria capable of causing pyelonephritis and renal injury, and to selectively target the gastrointestinal reservoirs of these bacteria for elimination using probiotics. Promising experimental studies correlating bacterial virulence with pattern of UTI and identification and characterization of a newly available probiotic capable of eradicating uropathogenic bacteria make targeted probiotic prevention of renal injury-inducing UTIs a potential therapeutic reality.

A modification of the Hynes procedure—A surgical innovation in the treatment of mature hypertrophic scars in children

In 1957, Hynes first described the shaving and grafting procedure for the treatment of mature hypertrophic scars (HTSs). This procedure involved excision of mature HTS using a scalpel blade followed by split-skin grafting (SSG). We have modified this technique through the novel application of Versajet™ (Smith & Nephew, Hull, UK) for the sub-total excision of mature HTS with SSG. To date, this modified technique has shown excellent cosmetic results. A review of cases and an example of the technique is provided.

Risk of Renal Scarring in Children With a First Urinary Tract Infection: A Systematic Review

To our knowledge, the risk of renal scarring in children with a urinary tract infection (UTI) has not been systematically studied. To review the prevalence of acute and chronic renal imaging abnormalities in children after an initial UTI. We searched Medline and Embase for English-, French-, and Spanish-language articles using the following terms: "Technetium (99m)Tc dimercaptosuccinic acid (DMSA)," "DMSA," "dimercaptosuccinic," "scintigra*," "pyelonephritis," and "urinary tract infection." We included articles if they reported data on the prevalence of abnormalities on acute-phase (≤15 days) or follow-up (>5 months) DMSA renal scans in children aged 0 to 18 years after an initial UTI. Two evaluators independently reviewed data from each article. Of 1533 articles found by the search strategy, 325 full-text articles were reviewed; 33 studies met all inclusion criteria. Among children with an initial episode of UTI, 57% (95% confidence interval [CI]: 50-64) had changes consistent with acute pyelonephritis on the acute-phase DMSA renal scan and 15% (95% CI: 11-18) had evidence of renal scarring on the follow-up DMSA scan. Children with vesicoureteral reflux (VUR) were significantly more likely to develop pyelonephritis (relative risk [RR]: 1.5 [95% CI: 1.1-1.9]) and renal scarring (RR: 2.6 [95% CI: 1.7-3.9]) compared with children with no VUR. Children with VUR grades III or higher were more likely to develop scarring than children with lower grades of VUR (RR: 2.1 [95% CI: 1.4-3.2]). The pooled prevalence values provided from this study provide a basis for an evidence-based approach to the management of children with this frequently occurring condition.

Risk of Renal Scarring in Children With a First Urinary Tract Infection: A Systematic Review

Risk of Renal Scarring in Children With a First Urinary Tract Infection: A Systematic Review

1010 Antimicrobial Resistance in Uropathogens in Children From Brazil

Background and aims: To prevent urosepsis and reduce risk of renal scarring in children with urinary tract infection (UTI), empirical antibiotic treatment is started soon after the collection of urine specimens for culture and should be based on local epidemiology of uropathogens and their antimicrobial susceptibility. The aim of this study was to describe pathogens and their antimicrobial resistance in urine cultures of children under five, attending the Instituto de Medicina Integral Professor Fernando Figueira (IMIP), a teaching hospital in Recife, Brazil.Methods: cross sectional study comparing an earlier (January 1999 to August 2001) and a later (January to December 2008) period of time. It was recorded the urine culture positivity rate, pathogen species; antimicrobial resistance (Kirby-Bauer diffusion disks) of isolates in urine cultures of children with suspected UTI.Results: 601 (15%) of 4113 urine cultures were positive. The most frequent isolates in the earlier and later periods were, respectively: E.coli (30% and 41%), Klebsiella spp (27% and 25%), P aeruginosa (5% and 9%), P. mirabilis (7% and 7%) and Candida spp. (11% and 4%). In 2008, the resistance of E.coli was (in descending order): cotrimoxazole (68%), nalidixic acid (52%), cephalotin (30%), ciprofloxacin (15%) and nitrofurantoin (8%). When all pathogens are considered, the highest antimicrobial coverages would be reached by ciprofloxacin (88%, CI95%=83.4-91.6%) and nitrofurantoin (75%, CI95% = 68.6-80.5 %).Conclusions: Nitrofurantoin and ciprofloxacin remain viable alternatives, respectively for uncomplicated and complicated UTI. Trends of antimicrobial resistance should be monitored at the local level as important changes occur over time.

984 Comparison of Dmsa Renal Scintigraphy and Micturating Cystouretrography in Children with Urinary Tract Infection

Background and aim: The relationship among urinary tract infection (UTI), vesicoureteral reflux (VUR) and permanent renal damage in children is not fully understood. We aimed to determine the change in probability of permanent renal damage due to the presence of VUR.Patients and Methods: 201 children with UTI, referred for dimercatpo-succinic renal scintigraphy (DMSA) 4-6 months after acute UTI. Micturating cystoureterography (MCU) was one month prior to DMSA. Likelihood ratio (LR) positive and negative, diagnostic odds ratio (DOR) and post test probability of (no) disease were calculated for VUR on MCU versus scarring on DMSA.Results: VUR was found in 118 patients. Of the 201 patients 55 (27.4 %) had permanent renal damage according to DMSA. Scarring was shown in 34.7% of patients with UTI and VUR and in 16.9% patients with UTI without VUR (p =0.005). LR positive was 1.274 (95% CI; 1.082, 1.500), LR negative (0.49, 95% CI: 0.28, 0.83) and DOR was 2.624 (95% CI; 1.319, 5.223). Rate of scarring significantly increased with VUR of grade III, IV and V. There was no significant difference in the incidence of scarring in children with UTI without VUR and children with low grade VUR (p=0.292). Presence of VUR on MCU increased the chance of renal damage on DMSA by about 13%, whereas the negative MCU increased the chance of no renal involvement by 8%.Conclusion: MCUG should not be used as a first line test to rule out the permanent renal damage due to UTI.

The IL-6 −174G/C polymorphism and renal scarring in children with first acute pyelonephritis

Urinary tract infections (UTI) are common in infants and children and may result in serious complications, such as renal scarring, hypertension, and renal failure. Identification of the new markers in relation to acute pyelonephritis (APN) and its treatment is essential for designing interventions that would minimize tissue damage. This prospective study investigated the first UTI infection in 71 children (age range: 1-24 months) in respect to interleukin-6 (IL-6) -174G/C polymorphism and renal scarring. The patients were divided into an APN group and a lower UTI group according to dimercaptosuccinic acid (DMSA). The IL-6 -174G/C genotypes were determined by tetra-primer ARMSPCR. Serum IL-6 was significantly higher in the APN group than in the group with lower UTI (p<0.05). In both groups, the -174G/C genotype and allele frequencies did not differ significantly from the control group. The highest white blood cell (WBC) count was observed in the CC genotype (p<0.05). A non-significant trend toward higher serum IL-6 was observed in children with CC genotype. On follow-up DMSA imaging performed 6 months later, renal scarring was detected in 36.9% of APN children. We did not find the significant association of IL-6 -174G/C polymorphism with APN and/or postinfectious renal scarring. These results indicate that serum IL-6 concentrations were significantly higher in children with APN than in patients with lower UTI.

Acute Lobar Nephronia Is Associated With a High Incidence of Renal Scarring in Childhood Urinary Tract Infections

Acute lobar nephronia (ALN) is a severe nonliquefactive inflammatory renal bacterial infection, and requires a longer duration of treatment. The aim of this prospective study was to investigate renal scarring after ALN and to examine the risk factors for renal scarring in children with ALN compared with those with acute pyelonephritis (APN). Patients with computed tomography-diagnosed ALN were enrolled and randomly allocated, with serial entry, to either a 2- or 3-week antibiotic treatment regimen. Age- and gender-matched APN patients served as comparators. Patients underwent dimercaptosuccinic acid scintigraphy at least 6 months later to assess renal scarring. A total of 218 children (109 ALN, 109 APN) were enrolled. The incidence of renal scarring was similar between 2- and 3-week treatment groups and was higher in ALN patients than in APN patients (89.0% vs. 34.9%, P < 0.001). Renal scarring was prone to occur in children with higher inflammatory indices and longer duration of fever before and after treatment. Multiple regression analysis on independent variables showed that only ALN was significantly associated with a higher incidence of renal scarring. Our results showed a new finding that ALN is associated with a very high incidence of renal scarring, in comparison to APN, irrespective of the duration of antibiotic treatment.

Fabricated expanded thoracodorsal artery perforator flap to repair cervical scar in children

To investigate ideal methods to repair cervical cicatricial contracture in children. The expanders were implanted subcutaneously around the cervical scar and above the latissimus. After expansion was completed, the cervical cicatricial contracture was released and the wound was covered with local expanded flaps and free expanded prefabricated thoracodorsal artery perforator flap, leaving no injury to thoracodorsal nerves and latissimus. The wound at the donor site was closed directly. From July 2007 to October 2009, 10 patients were treated. All the flaps survived completely. All the wounds were repaired totally and the deformities were corrected completely. The patients were followed up for 3-30 months. When the patients grew up, the flaps enlarged simultaneously. The flaps were not bulky and had a good color match. The scar at the donor site was inconspicuous with no functional morbidity. The fabricated expanded thoracodorsal artery perforator flaps is an ideal method for severe cervical cicatricial contracture in children.

Safety of Shock Wave Lithotripsy for Treatment of Pediatric Urolithiasis: 20-Year Experience

This retrospective study was designed to assess the impact of shock wave lithotripsy on the pediatric kidney using pretreatment and posttreatment (99m)technetium dimercapto-succinic acid renal scintigram. A total of 182 patients 5 months to 19.8 years old (mean 5.3 years) were treated for renal calculi with shock wave lithotripsy during a 20-year period. Pretreatment evaluation included clinical assessment, urine culture, renal ultrasound and plain abdominal radiograph with or without excretory urogram. Dimercapto-succinic acid scintigram was performed before and 6 months after completion of treatment in 94 patients (52%). Patients underwent 1 to 4 sessions of shock wave lithotripsy per kidney with at least 1 month between treatments. Median number of shocks delivered per session was 3,000 (IQR 2,601 to 3,005). No new scars were observed on any posttreatment dimercapto-succinic acid scan. Regarding renal function, patients fell into 1 of 4 groups. Group 1 (66 patients, 70%) had normal function on dimercapto-succinic acid scan before and after treatment, group 2 (18, 19%) had decreased function in the affected kidney on pretreatment scan with no change after treatment, group 3 (2, 2%) had impaired function in the treated kidney that was transient (1) or permanent (1) and group 4 (7, 7%) had improved function in the treated kidney. Shock wave lithotripsy is an effective treatment for renal calculi in children. Renal parenchymal trauma associated with extracorporeal shock wave lithotripsy does not seem to cause long-term alterations in renal function or development of permanent renal scars in children.

Value of Ultrasound in Evaluation of Infants With First Urinary Tract Infection

We evaluated the role of ultrasound in diagnosing and treating infants with a first urinary tract infection with a focus on important structural abnormalities. In a setting of limited prenatal ultrasound screening this population based, prospective, 3-year study included 161 male and 129 female infants. Ultrasound and dimercapto-succinic acid scintigraphy were performed as initial investigations and voiding cystourethrography was conducted within 2 months. Ultrasound revealed dilatation in 15% of patients and increased kidney length in 28%. Sensitivity for detecting scintigraphic abnormality was 48%. Renal length was significantly correlated to inflammatory parameters, including scintigraphic abnormalities. Important structural abnormalities were detected in 40 cases, with 30 on ultrasound, while 10 of 27 cases of dilating reflux (mostly grade III) were missed. Outside the study there were 28 additional cases of structural abnormality, of which 15 were detected prenatally. Ultrasound detected most structural abnormalities except grade III reflux. Since it is noninvasive, ultrasound has a place in the evaluation of infants with urinary tract infection, especially in the absence of prenatal ultrasound during late pregnancy. Kidney length in infants with acute infection correlated with inflammatory parameters, and the clinical importance of this finding needs to be studied further.

Cushing’s syndrome and adrenal insufficiency after intradermal triamcinolone acetonide for keloid scars

A 6-year-old girl was admitted to our hospital for excessive weight gain. On presentation, she had a typical Cushingoid appearance and hypertension. Laboratory analysis was indicative for an exogenous glucocorticoid source, showing values that were low for serum cortisol and adrenocorticotropin and for 24-h urinary glucocorticoid (metabolite) excretion. Five and 2 months before presentation, she was treated with intradermal triamcinolone acetonide for keloid scars. Recovery of intrinsic cortisol production occurred 12 months after the last steroid dose. Intradermal triamcinolone acetonide for keloid scars in children should be used with care taking into account the here reported complication.

ACE gene insertion/deletion polymorphism and renal scarring in children with urinary tract infections

Urinary tract infection is a common bacterial disease that presents during childhood and may lead to renal scarring. Several studies have shown a strong association between the angiotensin converting enzyme (ACE) deletion polymorphism and renal scarring in children with vesicoureteric reflux (VUR). The purpose of this study was to investigate the possible correlation between the ACE deletion polymorphism and renal scarring in 186 children with urinary tract infection (UTI), of whom 90 were renal scar positive and 96 were renal scar negative. The control group consisted of 129 children with no UTI. Renal scars were diagnosed by means of (99m)Tc-dimercapto-succinic acid scans, and ACE genotypes were determined as II, ID, and DD by PCR analyses. The ACE genotype distribution was 10% II, 67% ID, and 23% DD in the renal scar-positive group, 18% IotaIota, 42% ID, and 40% DD in the renal scar-negative group, and 22% II, 47% ID, and 31% DD in the control group. No correlation was found between the DD genotype and renal scar formation in children with UTI. The same results were obtained following strafication of the patients by VUR and age of the first urinary tract infection. In conclusion, the results of this study suggest that the DD genotype is not an independent risk factor for renal scarring in children with UTI.

The Role of Serum and Urine Interleukin-8 on Acute Pyelonephritis and Subsequent Renal Scarring in Children

Interleukin (IL)-8 acts as a potent neutrophils chemoattractant responsible for the migration of neutrophils into the infected renal tissue to protect against invading pathogens. The aim of this study was to assess the role of IL-8 on acute-phase pyelonephritis and later renal scarring in children. A total of 124 children with a first-time febrile urinary tract infection (UTI) were studied. The diagnosis of acute pyelonephritis was confirmed by Tc-dimercaptosuccinic acid (DMSA) renal scan. Serum and urine samples were obtained from 124 children with UTI and 20 healthy children for IL-8 measurement. The 124 children were divided into acute pyelonephritis (n = 70) and lower UTI (n = 54) groups according to the results of DMSA scans. The initial serum and urine IL-8 values of children with acute pyelonephritis were significantly higher when compared with lower UTI and healthy controls (all P < 0.001). Renal scarring was seen in 26 (38.8%) of these 67 children with acute pyelonephritis at follow-up DMSA scans. Both the initial serum and urine IL-8 concentrations were significantly higher in children with renal scarring than in those without (both P < 0.001). The mean age of children with renal scarring was also significantly lower than those without scarring (P = 0.004). Multivariate analysis showed that the highest initial IL-8 values, age <20 months and reflux grades > or =III all were independent predictors of renal scarring. Those children younger than 2 years of age with the highest IL-8 concentrations during the acute phase of pyelonephritis as well as children with reflux grades of III or greater are at a high-risk for developing renal scarring in the future.

Can prompt treatment of childhood UTI prevent kidney scarring?

The aim of the study reported here was to determine whether kidney scarring after urinary tract infections (UTI) in children can be prevented and to identify the risk factors for developing scars. We identified children in the Northern health region of the UK who had been seen to develop scars, identified as new defects on dimercapto-succinic acid (DMSA) scanning. Risk factors were sought by reviewing case-notes and interviews with parents. Twenty girls were identified whose new scarring was strongly associated with having both vesicoureteric reflux (VUR) and a UTI (p = 0.0001); 19/23 (83%) of kidneys exposed to both of these factors developed scars. Children were much more likely to be febrile (94 vs. 30%, p < 0.0001) or unwell (82 vs. 10%, p < 0.0001) during their earlier UTIs when they were of median age 2.8 years (range 0.3-5.0 years) and did not scar, compared to their later UTIs at age 7.3 years (1.2-12.5 years), when they did scar. However, most patients were treated within 1 day of their symptoms for their early UTIs, compared to a wait >or=7 days for later UTIs (p = 0.001). Being febrile or unwell during a UTI does not predict the development of scars, but prompt treatment appears to prevent scarring in children with VUR.

Renal scarring in children with urinary tract infections

The Journal is the primary organ of Continuing Paediatric Medical Education in Sri Lanka. The journal also has a website. Free full text access is available for all readers.The Sri Lanka Journal of Child Health is now indexed in SciVerse Scopus (Source Record ID 19900193609), Index Medicus for South-East Asia Region (IMSEAR), CABI (Centre for Agriculture and Bioscience International Global Health Database), DOAJ and is available in Google, as well as Google Scholar.The policies of the journal are modelled on the Committee on Publication Ethics (COPE) Guidelines on Principles of Transparency and Best Practice in Scholarly Publishing. Sri Lanka Journal of Child Health is recognised by the International Committee of Medical Journal Editors (ICMJE) as a publication following the ICMJE Recommendations.