Does prompt treatment of urinary tract infection in preschool children prevent renal scarring: mixed retrospective and prospective audits. Issue 4 (18th December 2013)

• Record Type: Journal Article
• Authors: Coulthard, Malcolm G; Lambert, Heather J; Vernon, Susan J; Hunter, Elizabeth W; Keir, Michael J; Matthews, John N S
• Is Part Of: Archives of disease in childhood. Volume 99:Issue 4(2014)
• Page Start: 342
• Page End: 347
• Publication Date: 2013-12-18
• Subjects: urinary tract infection -- vesicoureteric reflux -- renal scarring -- prompt treatment; Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2013-304428
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Objective: To test whether active management of urinary tract infections (UTI) in young children by general practitioners can reduce kidney scarring rates. Design: A comparison of two audits in Newcastle, of children aged <8 years, presenting with UTIs ; a retrospective audit of conventional management during 1992–1995 (1990s) versus a prospective audit of direct access management during 2004–2011 (2000s). Main outcome measures: Kidney scarring rates, and their relationship with time-to-treat. Results: Children with a first UTI in the 2000s compared to those in the 1990s, were referred younger, were half as likely to have a renal scar (girls OR 0.47, 95% CI 0.29 to 0.76; boys 0.35, 0.16 to 0.81), and were about 12 times more likely to have vesicoureteric reflux without scarring (girls 11.9, 4.3 to 33.5; boys 14.4, 4.3 to 47.6). In the 2000s, general practitioners treated about half the children at first consultation. Children who were treated within 3 days of their symptoms starting were one-third as likely to scar as those whose symptoms lasted longer (0.33, 0.12 to 0.72). Interpretation: Most kidney defects seen in children after UTIs, are acquired scars, and in Newcastle, active management in primary care has halved this rate.