A model including temperature, ultrasonographic findings, and etiologic organisms is able to predict renal scarring in children with a first urinary tract infection, according to research published online in JAMA Pediatrics.
Nader Shaikh,MD, MP, from the University of Pittsburgh, and colleagues conducted a meta-analysis to identify independent prognostic factors for the development of renal scarring. Individual patient data from 9 cohort studies for patients aged 0 to 18 years with a first urinary tract infection were pooled. Three models were assessed: clinical and ultrasonographic findings (model 1); model 1 plus serum levels of inflammatory markers (model 2); and model 2 plus voiding cystourethrogram findings (model 3).
The researchers found that 15.5% of the 1,280 participants had renal scarring. The development of renal scars correlated with a temperature of 39 degrees Celsius or more; an etiologic organism other than Escherichia coli; abnormal ultrasonographic findings; polymorphonuclear cell count greater than 60%; C-reactive protein level above 40 mg/L; and vesicoureteral reflux.
The predictive ability of model 1 with temperature, ultrasonographic findings, and etiologic organism was only 3% to 5% less than that of models requiring blood draw and/or voiding cystourethrogram. At a model 1 score cut-off of 2 or more, 44.9% of patients with eventual renal scarring were identified.
“Children and adolescents with an abnormal renal ultrasonographic finding or with a combination of high fever (≥39 degrees Celsius) and an etiologic organism other than E. coli are at high risk for the development of renal scarring,” the authors concluded.