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Does prompt treatment of urinary tract infection in preschool children prevent renal scarring: mixed retrospective and prospective audits
  1. Malcolm G Coulthard1,
  2. Heather J Lambert1,
  3. Susan J Vernon1,
  4. Elizabeth W Hunter2,
  5. Michael J Keir3,
  6. John N S Matthews4
  1. 1Paediatric Nephrology Unit, Great North Children's Hospital, Newcastle, UK
  2. 2Paediatric Radiology Department, Great North Children's Hospital, Newcastle, UK
  3. 3Department of Regional Medical Physics, Royal Victoria Infirmary, Newcastle, UK
  4. 4School of Mathematics and Statistics, Newcastle University, Newcastle, UK
  1. Correspondence to Dr Malcolm G Coulthard, South Park House, South Park, Hexham, Northumberland NE46 1BS, UK; malcolm.coulthard{at}nuth.nhs.uk

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.

  • urinary tract infection
  • vesicoureteric reflux
  • renal scarring
  • prompt treatment

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