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Open Access Highly Accessed Research article

Further investigation of confirmed urinary tract infection (UTI) in children under five years: a systematic review

Marie E Westwood*, Penny F Whiting, Julie Cooper, Ian S Watt and Jos Kleijnen

BMC Pediatrics 2005, 5:2  doi:10.1186/1471-2431-5-2

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Follow up routines of UTI might not prevent permanent renal damage

Sven Bremberg   (2005-03-20 15:10)  National Institute of Public Health Stockholm email

I would like to draw to your attention a study that support the conclusions in this paper although not included in the review, Bremberg S, Edström S. Outcome assessment of routine medical practice in handling child urinary tract infections - estimation of renal scar incidence. Ambulatory Child Health 2001;7(3/4):149-156. In this study the incidence of renal scars was investigated in a defined population in Sweden. In 1990–95 the incidence of children with renal scars was 9.3 per 100000 child–years with a possible range from 7.5 to 11. The medical handling was close to optimal including use of current imaging techniques and a median time between the debut of symptoms and treatment with antibiotics was 48 hours. The incidence of renal scars was as high as in a population based Swedish study from the 1960s, in spite of the improved quality of medical care since the 1960s. This finding calls into question the assumption that further improvement of medical care of urinary tract infections might prevent permanent renal damage.

Competing interests

No competing interest

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DMSA scanning still is the optimal tool to detect upper UTI in young kids

Abbas Al-Abbad   (2005-03-19 13:00)  King FAisal Specialist Hospital and Research Center email

From our experience over the last 15 years or so, we found that DMSA scan is the best tool to detect an upper UTI in infants.

In kids between 2 and 5 years, It is again the best investigative tool when even high resolution US fails to demonstrate pyelonephritis.

Competing interests

It would be more solid to compare DMSA reliability with MRI when there is strong clinical edvidence in the absence of negative urine culture.

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