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

Cheng, Chi-Hui MD*†; Tsau, Yong-Kwei MD; Chang, Chee-Jen PhD†§; Chang, Yu-Chen MD¶∥; Kuo, Chen-Yen MD*; Tsai, I-Jung MD; Hsu, Yi-Hsien MS§; Lin, Tzou-Yien MD*∥

The Pediatric Infectious Disease Journal: July 2010 - Volume 29 - Issue 7 - p 624-628
doi: 10.1097/INF.0b013e3181d8631a
Original Studies

Background: 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).

Methods: 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.

Results: 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.

Conclusions: 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.

From the *Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Taoyuan, Taiwan; †Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; ‡Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; §Resource Center for Clinical Research, and ¶Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; and ∥College of Medicine, Chang Gung University, Taoyuan, Taiwan.

Accepted for publication January 21, 2010.

Address for correspondence: Yong-Kwei Tsau, MD, Department of Pediatrics, National Taiwan University Hospital, No. 7 Chung-Shan South Rd, Taipei 100, Taiwan. E-mail: tsauyk@ntu.edu.tw.

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© 2010 Lippincott Williams & Wilkins, Inc.