Search

Acute urinary tract infections are relatively common in children, with 8 percent of girls and 2 percent of boys having at least one episode by seven years of age. The most common pathogen is Escherichia coli, accounting for approximately 85 percent of urinary tract infections in children. Renal parenchymal defects are present in 3 to 15 percent of children within one to two years of their first diagnosed urinary tract infection. Clinical signs and symptoms of a urinary tract infection depend on the age of the child, but all febrile children two to 24 months of age with no obvious cause of infection should be evaluated for urinary tract infection (with the exception of circumcised boys older than 12 months). Evaluation of older children may depend on the clinical presentation and symptoms that point toward a urinary source (e.g., leukocyte esterase or nitrite present on dipstick testing; pyuria of at least 10 white blood cells per high-power field and bacteriuria on microscopy). Increased rates of E. coli resistance have made amoxicillin a less acceptable choice for treatment, and studies have found higher cure rates with trimethoprim/sulfamethoxazole. Other treatment options include amoxicillin/clavulanate and cephalosporins. Prophylactic antibiotics do not reduce the risk of subsequent urinary tract infections, even in children with mild to moderate vesicoureteral reflux. Constipation should be avoided to help prevent urinary tract infections. Ultrasonography, cystography, and a renal cortical scan should be considered in children with urinary tract infections. [ABSTRACT FROM AUTHOR]

The article presents information on a study conducted on severe haemolytic uremic syndrome (HUS) caused in children by Shiga toxin-producing E. coli (STEC) during an epidemic. The study found that cerebral oedema and hernia caused the death of a 4-year-old boy; and two patients developed necrosis of colon with perforation. The study concluded that the outbreak of STEC resulted in a high incidence of HUS among the infected children, and many developed severe renal disease.

The role of antimicrobial prophylaxis in vesicoureteral reflux (VUR) has come under increasing scrutiny because of better analytical methods in the published literature, knowledge gained from VUR and renal scars diagnosed without preceding urinary tract infection (UTI), and better renal imaging modalities for diagnosing renal scars. A meta-analysis of the five recent randomized studies with a total of 809 patients with VUR diagnosed after UTI reveals a relative risk of UTI recurrence of 0.82 [95% confidence interval (CI) 0.62-1.08; p = 0.16) with prophylaxis. A meta-analysis of the four studies with a total of 662 patients with UTI with and without VUR evaluated for renal scarring reveals a relative risk of 1.04 (95% CI: 0.84-1.30; p = 0.69), according to Springer style?> with prophylaxis. However, these observations need to be interpreted with caution because of the limitations with these studies and their heterogeneity for meta-analysis, particularly for renal scarring. More research is needed to validate the role of prophylaxis in VUR diagnosed after UTI, and even more research is warranted to answer the questions regarding antimicrobial prophylaxis across the spectrum of VUR in different clinical settings. [ABSTRACT FROM AUTHOR]

This study evaluates the impact of pediatric uninary tract infection (UTI)s on the economy and inpatient healthcare utilization in the USA. A retrospective analysis of patient demographics and hospital economics was performed on children less than 18 years of age admitted with a UTI between 2000 and 2006 using the Healthcare Cost and Utilization Project Kids' Inpatient Database. Our results were stratified as follows. Hospital admissions-nearly 50,000 children/year were admitted with a UTI. Pediatric UTIs represented 1.8% of all pediatric hospitalizations. Seventy-three percent of patients were female and 40% were under 1 year of age. Payer information-from 2000 to 2006, pediatric insurance coverage shifted from the private sector to the public sector. Hospital cost-in 2000, estimated hospital costs for UTIs were $2,858 per hospitalization and rose to $3,838 by 2006. Mean hospital charges increased from $6,279 to $10,489 per stay. By 2006, aggregate hospital charges exceeded $520 million. Our results indicate that UTIs are among the most common pediatric admission diagnoses. Hospitalization is more common in females and younger children. Since 2000, hospital charges for UTIs increased disproportionately to hospital costs. Over time, more children hospitalized with a UTI depend on public agencies to cover healthcare expense. More efforts are needed to evaluate cost-effective strategies for evaluation and treatment of UTIs. [ABSTRACT FROM AUTHOR]

We conducted a retrospective multicenter review to estimate the prevalence of urological abnormalities in Chinese children with first febrile urinary tract infection (UTI) and to evaluate the selective imaging strategy recommended by the NICE guideline for detecting underlying abnormalities. Atypical UTI was defined as in the NICE UTI guideline. Overall, 576 boys and 244 girls aged below 24 months were reviewed. All underwent ultrasound (US) and micturating cystourethrogram (MCUG) and 612 underwent DMSA scans. US was abnormal in 73 (8.9%) and vesicoureteral reflux was shown in 195 patients (23.8%). A total of 126 patients were considered to have remediable urological abnormalities requiring additional surgical or medical interventions. The NICE guideline yielded excellent negative predictive values (NPV) of 100–94.4% in girls but 91% in boys. If all boys underwent US and DMSA and only those with atypical UTI or abnormal US or DMSA proceeded to MCUG, then the NPV increased to 95.2% and 97.4% for boys aged below and above 6 months, respectively. These revised strategies would substantially save invasive studies—DMSA and MCUG in 27 and 74% of girls aged below and above 6 months, respectively, or MCUG in 23 and 59% of boys aged below and above 6 months, respectively. [ABSTRACT FROM AUTHOR]

The article presents a systematic review which addresses the issue of whether antibiotic prophylaxis in children suffering from urinary tract infection (UTI) prevent the recurrence, renal scarring and long-term complications. According to a meta-analysis, the risk of recurrence was lessened with antibiotic prophylaxis when all the participants were considered together. Also mentioned is the failure of antibiotic prophylaxis to prevent new/worsening renal scarring in children with vesico-ureteral reflux (VUR).

OBJECTIVE: To evaluate the effectiveness and safety of long-term prophylactic antibiotics for recurrent urinary tract infection (UTI) in children through meta-analysis of randomised controlled trials. METHODS: Electronic databases and reference lists of review articles were searched for relevant trials. Outcome measures were recurrence of symptomatic UTI, repeat positive urine culture, new or deteriorated renal scarring and adverse events during and after treatment. RESULTS: Eleven trials with 2046 patients were identified. Analysis suggested rates of recurrent symptomatic UTI were not significantly different between antibiotic (12.4%) and control groups (15.5%) (RR 0.83, 95% CI 0.66 to 1.05). Subsequent sensitivity and subgroup analyses according to patient vesicoureteric reflux (VUR) status, patient characteristics, history of UTI, site of UTI and duration of treatment also produced no significant effect. However, when trials were divided by study quality, only in trials with adequate allocation concealment was recurrent symptomatic UTI reduced by antibiotic prophylaxis. Prophylactic antibiotics reduced the risk of repeat positive urine culture (RR 0.50, 95% CI 0.34 to 0.74). A subgroup analysis limited to patients without VUR showed similar results (0.52, 0.33 to 0.83), whereas patients with VUR showed a non-significant decrease (0.82, 0.61 to 1.09) in risk of repeat positive urine culture. Seven studies reported the rate of new or deteriorated renal scars and showed no significant difference (0.95, 0.51 to 1.78). CONCLUSIONS: Evidence is lacking that prophylactic antibiotics reduce the incidence of recurrent childhood UTI. Since the reviewed studies had limitations in methodological design, large scale, high quality, placebo-controlled, double-blind trials are required. [ABSTRACT FROM AUTHOR]

Objective: Urinary tract is one of the most common sources of infection in children under the age of two years. Many known and unknown risk factors predispose to this important disease in children. This study was conducted to determine whether using a specific type of diaper plays a role in urinary tract infection (UTI) in girls under the age of 2 years. Methods: This case control study was performed in hospitalized children; girls with their first urinary tract infection were selected as cases, and those admitted for other reasons comprised the control group. Two groups were matched for age (±1 month), and other known risk factors for UTI. Type of diapers (superabsorbent, standard disposable and washable cotton), used for these children during six months, from October 2007 to March 2008, were compared in both groups. Findings: Fifty-nine matched pair infant girls less than 2 years were selected. It was revealed that in cases with UTI superabsorbent diapers were used more frequently than in controls (Odds ratio =3.29, P-value=0.005) There were no significant differences in other factors like number of diapers used per day, the time between defecation and diaper change, mothers' educational level, level of family income and mother's occupation. Conclusion: The use of superabsorbent diapers could be a risk factor for urinary tract infection in infant girls. [ABSTRACT FROM AUTHOR]

Urinary tract infections (UTIs) are common in children, but the routine work-up and treatment recommendations are still controversial. Long-term complications, including renal scarring, hypertension, and renal failure, have been the main concern and the reason for use of antibiotic prophylaxis and invasive imaging techniques. In the past several years, numerous studies have been published comparing different imaging protocols and questioning the use of antibiotic prophylaxis. The latest guidelines from the United Kingdom, published in 2007, recommend more selective approach based on evidence. In this review, we critically appraise the literature published in the past 5 years. The risk of developing long-term complications after a UTI is extremely low, and the evidence suggests selective imaging to a select group of children at risk. Finding those at risk for long-term complications is yet to be determined. [ABSTRACT FROM AUTHOR]

The article discusses the causes and effects of congenital urinary bladder outlet obstruction (BOO) to health. It says that the causes of BOO include prolapsed ureterocoele, syringocoele, and obstruction by hydrocolpos in females with cloacal anomalies. On the other hand, patients with BOO may experience neonatal respiratory failure, oligohydramnios, and lack of lung development.

Aim: To identify risk factors for a child with Henoch-Schönlein purpura (HSP) either to develop nephritis (HSPN) or to contract progressive course and to obtain the currently available evidence on the efficacy of treatment options in both preventing and treating the established renal disease. Method: Review of the literature published over the last two decades. Results: Persistent or recurrent purpura, severe abdominal symptoms and an older age proved as the most significant risk factors for later HSPN. The risks of long-term renal impairment are the highest in children having at presentation nephritic/nephrotic syndrome and/or more than 50% of glomeruli occupied by large crescents or sclerosing lesions. Randomized controlled trials (RCT) do not support short course prednisone at presentation of HSP in preventing persistent renal disease. Many uncontrolled studies using various treatment regimens have reported outcomes considered better than expected. However, the data from RCTs are sparse and no treatment options for the established renal disease can be currently recommended based on RCTs. Conclusion: Severity and/or duration of extrarenal HSP symptoms and an older age are the most significant risk factors for developing HSPN, whereas clinical and histological severity at HSPN onset are in general predictive of a long-term renal impairment. The existing evidence does not support of short course prednisone in preventing persistent renal disease. A well-designed RCTs are needed in children with moderately severe or rapidly progressive (crescentic) HSPN. [ABSTRACT FROM AUTHOR]

Background: Antibiotic prophylaxis in children who have had urinary tract infection (UTI) to prevent further infection is a common practice. The aim of this study is to reduce the development of further renal scarring by the prevention of recurrent acute pyelonephritis. Methods: A systematic review of randomized controlled trials assessing effectiveness of antibiotic prophylaxis in children who have recovered from a symptomatic UTI and children in whom vesico-ureteric reflux has been identified independent of a history of acute UTI was carried out by systematic search in Medline, EMBASE, the Cochrane Library and CINAHL using keywords and thesaurus terms. Identified trials were independently appraised by two researchers. Data were extracted and synthesized in meta-analyses. Results: A total of 677 children in eight trials were included in the analyses. There was no evidence of difference on meta-analysis of all the included studies, or any of the four subgroups, between the intervention and control groups in recurrence of symptomatic UTI [four trials, RR 0.96 (95% CI: 0.69–1.32]) and incidence of new or progressive renal scarring [four trials, overall RR 1.15 (95% CI: 0.75–1.78)]. Conclusion: Given the lack of evidence on positive benefit of using prophylactic antibiotics for children at risk of developing UTI, routine use of antibiotics for these children is not recommended. [ABSTRACT FROM AUTHOR]

Urinary tract infections, with or without reflux, are the most frequent reason for long-term antibacterial prophylaxis in infants and children. When one is considering the use of prophylaxis in these children, what is clear from existing published data? Up to 2006 there were a small number of poor quality studies, with no reliable evidence of the effectiveness of antibiotics in preventing recurrent symptomatic urinary tract infections (UTIs). Since then, four randomised controlled studies, to assess the benefits, or lack thereof, of antibiotic prophylaxis, have been published. None has demonstrated a clear benefit. The following conclusions can be drawn: antibiotic prophylaxis is not indicated for children following a first febrile UTI if no or mild grade I or II reflux is present; for higher grade reflux there is no definite conclusion. [ABSTRACT FROM AUTHOR]

This retrospective study aimed to evaluate the applicability of the selective approach of imaging infants < 6 months old with urinary tract infection (UTI) according to the UTI guidelines of the National Institute for Health and Clinical Excellence (NICE) 2007. Infants < 6 months old with their first UTI from January 2001 to December 2006 having undergone an ultrasound examination of the urinary tract, a micturating cystourethrogram, and a late di-mercaptosuccinic acid (DMSA) scan, were included. Their condition was evaluated against a set of risk features according to the UTI guidelines. Those having any one of these were classified as atypical and those having none as typical. There were 134 infants reviewed, with a typical (98 infants) to atypical (36 infants) ratio of 2.7 to 1. Girls were found to be relatively more represented in the atypical group [male (M):female (F) = 1.3:1] than in the typical group (M:F = 4.4:1) ( P < 0.004). There were significantly more infants with abnormal micturating voiding cystourethrograms (MCUGs) ( P = 0.007), more refluxing ureters ( P < 0.001) and more significant vesico-ureteral reflux (VUR) (≥ grade III) ( P = 0.013) in the atypical group than in the typical group; while there was no significant difference in ultrasound (US) and DMSA scan findings between the two groups. In the atypical group there was no difference in imaging studies (and, thus, the results) between the conventional practice and the NICE UTI recommendation. In the typical group, if the recommendations of the guidelines had been followed (i.e. only those with abnormal US would have been further investigated), 25 refluxing ureters and 22 scarred kidneys would have been left undiagnosed. In conclusion, application of the suggested selective imaging approach would leave a significant number of VUR and renal scars undiagnosed, and it may not be an optimal practice for infants less than 6 months old with their first UTI. The best approach remains to be clarified. [ABSTRACT FROM AUTHOR]

Vesicoureteral reflux (VUR) affects around 1% of all children. It carries an increased risk of febrile urinary-tract infections (UTIs) and is associated with impaired renal function. Antibiotic prophylaxis is an established approach to managing the condition, but it does not protect against UTI and encourages bacterial resistance. Ureteral re-implantation (open surgery) is a relatively traumatic procedure typically requiring hospitalization, and there is a risk of significant post-treatment complications. Endoscopic treatment with NASHA/Dx gel (Deflux®) is minimally invasive, well tolerated and provides cure rates approaching those of open surgery: 80-90% in several studies. It has also been shown to be effective in a variety of ‘complicated’ cases. Thus, endoscopic treatment is generally preferable to open surgery and long-term antibiotic prophylaxis. Non-treatment of VUR is being discussed as an alternative option, although this mainly appears suitable for children with low-grade reflux and normal kidneys. A new approach to managing VUR may be considered, with treatment decisions based not only on the grade of reflux but also on factors such as age, sex, renal scarring and bladder dysfunction. Open surgery would be reserved only for use in the 10-15% of children not responding to endoscopic treatment and those with severe ureteral anomalies. [ABSTRACT FROM PUBLISHER]

OBJECTIVE: To determine the benefits and harms of therapies used to prevent or treat renal involvement in Henoch-Schönlein purpura. DESIGN: Systematic review of randomised controlled trials. SETTING: Secondary and tertiary paediatric and paediatric nephrology services. SUBJECTS: Ten trials involving 1230 children aged less than 18 years. MAIN OUTCOME MEASURES: Persistent proteinuria and/or haematuria. RESULTS: Meta-analyses of four trials showed no significant difference in the risk of persistent kidney disease at 6 months (379 children; relative risk (RR) 0.51, 95% CI 0.24 to 1.11) and 12 months (498 children; RR 1.02, 95% CI 0.40 to 2.62) in children given prednisone for 14–28 days at presentation of Henoch-Schönlein purpura compared with placebo or supportive treatment. In children with severe renal disease, there was no significant difference in the risk of persistent renal disease with cyclophosphamide compared with supportive treatment (one trial; 56 children; RR 1.07, 95% CI 0.65 to 1.78) and with cyclosporin compared with methylprednisolone (one trial; 19 children; RR 0.39; 95% CI 0.14 to 1.06). CONCLUSIONS: Data from randomised trials for any intervention used to improve renal outcomes in children with Henoch-Schönlein purpura are very sparse except for short-term prednisone, which has not been shown to be effective. [ABSTRACT FROM AUTHOR]

The article discusses a study that reviewed the clinical significance of vesicoureteral reflux in children. It was noted that VUR was claimed to be common in children with urinary tract infection (UTI), but rare in healthy children. The authors concluded that VUR does not significantly increase the risk of recurring UTI or the development of new renal scars, but noted that the prompt diagnosis and treatment of UTI is important for preventing renal scarring and renal failure.

The article presents abstracts of studies related to pediatric nephrology. They include "Ultrasound Bladder Measurements Can Replace Urodynamic Study for Diagnosis of Non-Monosymptomatic Nocturnal Enuresis," "Uneffectiveness of Antibiotic Prophylaxis in Children with VUR: Preliminary Data From a Controlled Study" and "Glomerular Sclerosis in Kidneys With Congenital Nephrotic Syndrome (NPHS1)."

Objective. We evaluated the efficacy of medical and surgical treatment of vesicoureteral reflux (VUR) in children by means of a meta-analysis, using the recurrence of urinary tract infections (UTIs), renal growth and renal scarring as endpoints. Material and methods. We performed a MEDLINE search for articles published in the English language between 1966 and 2002. Of 639 relevant articles found, 139 were chosen for a close review and the main database was supplemented with some additional articles derived from the references of these reviewed articles. Five studies were found acceptable for a meta-analysis. We reviewed all articles independently. All reviewers had to approve the accepted articles and data that were used in this meta-analysis. Results. Operative treatment of VUR was better than medical treatment in terms of abolishing reflux (OR?=?0.033; 95% CI 0.010–0.107). We found no statistically significant differences between surgically and medically treated patients in terms of kidney growth (OR?=?2.46; 95% CI 0.74–8.16), scarring (OR?=?1.05; 95% CI 0.71–1.55) or recurrence of UTIs (OR?=?0.80; 95% CI 0.49–1.29). We could not evaluate possible differences in the parameters monitored between boys and girls because of a lack of data. Conclusions. Although surgical treatment of VUR is a common pediatric urologic procedure, the data relating to it are scanty. We found no clinically significant differences between surgical and medical treatment for VUR other than in the resolution of VUR itself. On the basis of present evidence we suggest that a child with UTI and significant VUR should be treated conservatively at first and that surgical treatment should be reserved for children who experience problems with antimicrobials or persistent clinically significant VUR after several years of follow-up. [ABSTRACT FROM AUTHOR]

Objective We reviewed the prenatal and postnatal management of fetal lower urinary tract obstruction (LUTO) in a large geographically defined population. Methods The records of 113 cases of LUTO seen over a 14-year period were examined. The predictive accuracy of prenatal findings for chronic renal failure (CRF) and a comparison of prenatal-suspected and non-suspected cases were made. Results The incidence of LUTO was 2.2 in 10 000 births. During the study period, prenatal detection improved from 33 to 62%. Sensitivity of prenatal ultrasound detection of renal dysplasia and fetal urinary sodium, calcium, and beta2-microglobulin for CRF or renal dysplasia on autopsy were 59, 33, 66, and 63% respectively. Compared to undetected cases, those detected prenatally had higher mortality and a higher rate of CRF at 24 months (17% vs 57%, p < 0.01). Conclusion Our observations confirm the poor prognosis associated with fetal LUTO. The value of serial fetal urine biochemistry, other prenatal predictors of postnatal renal function, and the benefits of vesicoamniotic shunting require larger series and longer follow-up. Copyright © 2005 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Abstract Background: Recent widespread use of ultrasound has led to new efforts at screening for congenital kidney and urinary tract abnormalities. However, a standard screening methodology, criteria defining abnormalities, and follow-up procedures remain to be established. In order to establish screening criteria for these abnor­malities, we performed a preliminary study in 800 1-month-old infants using provisional methods and criteria. Methods: Based on the results of preliminary study, we screened 2700 1-month-old infants in a prospective study using the criteria of renal size (longitudinal diameter ≤35 mm or ≥60 mm, or a difference between sides of ≥10 mm), and of pelvic dilatation (Society for Fetal Urology [SFU] grade 2 or higher) as positive at the first ultrasound screening. We used the SFU grading system instead of anteroposterior pelvic diameter measurements for pelvic dilatation. Results: One hundred and twelve (4.1%) of the 2700 infants had abnormalities at the first ultrasound screening, while 18 (0.67%) had congenital kidney and urinary tract abnormalities on further examination. Use of the SFU grading system enabled us to reduce the false-positive rate at first screening, while maintaining a high diagnostic rate. The abnormalities consisted of ureteropelvic junction obstruction in seven infants, megaureter in two, hypoplastic kidney in four, vesicoureteral reflux in six (three were accompanied by hypoplastic kidneys or multicystic dysplastic kidney), multicystic dysplastic kidney in one, and horseshoe kidney in one. Conclusion: These results indicate that our screening methods and criteria are useful variables for detecting congenital kidney and urinary tract abnormalities. [ABSTRACT FROM AUTHOR]

The assessment of the mechanical properties of the respiratory system is typically done by oscillating flow into the lungs via the trachea, measuring the resulting pressure generated at the trachea, and relating the two signals to each other in terms of some suitable mathematical model. If the perturbing flow signal is broadband and not too large in amplitude, linear behavior is usually assumed and the input impedance calculated. Alternatively, some researchers have used flow signals that are narrow band but large in amplitude, and invoked nonlinear lumped-parameter models to account for the relationship between flow and pressure. There has been little attempt, however, to deal with respiratory data that are both broadband and reflective of system nonlinearities. In the present study, we collected such data from mice. To interpret these data, we first developed a time-domain approximation to a widely used model of respiratory input impedance. We then extended this model to include nonlinear resistive and elastic terms. We found that the nonlinear elastic term fit the data better than the linear model or the nonlinear resistance model when amplitudes were large. This model may be useful for detecting overinflation of the lung during mechanical ventilation. © 2003 Biomedical Engineering Society. PAC2003: 8719Rr, 8719Uv [ABSTRACT FROM AUTHOR]

Abstract Background : Almost all newborns have phimosis, which is known as one of the risk factors for urinary infection. The present study analyzed which specific prepuce conditions correlated with the development of febrile urinary infection in Japanese male infants. Methods : The subjects consisted of 100 children, 64 boys and 36 girls, with febrile urinary infection. Prepuces were classified by their retractability in the male patients and in 714 healthy boys. Results : Ninety-four percent of first febrile urinary infections occurred before 7 months of age in boys, whereas only 37% of the girls had first infections by that age. The prepuce covered the external urethral meatus in 96% of the healthy boys aged 3 years or less. A gentle retraction maneuver could not uncover the urethral meatus in approximately 40% of the boys aged 0-6 months. The frequency started to decline spontaneously after that age. Male patients aged 0-6 months significantly more often had tightly covered meatus than did healthy neonates (85%vs 42%, P < 0.0001). Conclusions : These findings indicate that it is specifically those boys whose external urethral meatus are tightly covered with foreskin who constitute the high-risk group for urinary infection. Awareness of this observation should help with diagnosing and managing urinary infection in young boys. [ABSTRACT FROM AUTHOR]

Examines gene deletions in Alport syndrome-mental retardation. Presence of a mental retardation contiguous gene syndrome at Xq22.3; Dysmorphic phenotype associated with mental retardation; Gene mutation.

Editorial. Comments on the benefits of sonography for the detection and management of urinary tract infection. Frequency of the urinary tract malformations; Sensitivity of the ultrasound detection; Access of the patient to a range of management options.

Indirect fluorescent antibody assay (IFA) is the most reliable test for detecting antibody to Bartonella henselae in the diagnosis of cat scratch disease (CSD). Recently, an ELISA test has been proposed, but conflicting results are reported. We compared IgG-IFA and IgG-IgM ELISA methods in CSD patients and in healthy children. We also tested ELISA specificity in a large group of healthy controls and in children with lymphoma-associated lymphadenopathy and with pyogenic lymphadenitis. The ELISA procedure was positive in 69/78 patients with CSD (sensitivity 89.6%), in 5/100 healthy children (specificity 95%), in 2/51 patients with non-Hodgkin's lymphoma or pyogenic lymphadenitis (specificity 96%) and in 27/296 blood donors (specificity 91.6%). In 34 patients with CSD, ELISA IgM and IgG responses decreased significantly between time of diagnosis of the disease and recovery. We found significantly higher IgG-ELISA titres in cat-owners, whether blood donors or healthy children, than in non-cat-owners. The IgG-IFA test gave positive results in 69/78 patients with CSD (sensitivity 89.6%) and in 5/62 healthy controls (specificity 92.5%). The ELISA method is a cheap, sensitive method for determining antibody response to Bartonella henselae infection and is also important for evaluating the clinical course of the disease and the efficacy of antibiotic therapy. The high specificity of ELISA in patients with non-Hodgkin's lymphoma will help the clinician to exclude a potentially life-threatening disease associated with lymphadenopathy. [ABSTRACT FROM AUTHOR]

There has been a low yield of primary vesicoureteric reflux (VUR) from screening the fetal urinary tract during obstetric sonography. We sought to determine whether changing the cut-off level of fetal renal pelvic diameter from 10 mm to 4 mm would improve the yield of VUR. In a prospective community-based study, a fetal renal pelvic diameter of 4 mm or more on a transverse view of the fetal renal hilum at obstetric sonography after 16 weeks' gestation was found in 426 fetuses from 9,800 consecutive pregnancies. After birth, renal sonography was performed on 386 of the 426 babies. Of the 386 babies, 264 (187 boys) had a voiding cystourethrogram (VCUG) at a mean age of 9 weeks. Primary VUR was detected in 33 (16 boys) of the 264 infants (13%), and secondary VUR in another 5 (2%). Only 5 of the 33 (15%) babies with primary VUR would have been detected if a cut-off point of 10 mm for fetal renal pelvic diameter had been used. The prevalence of reflux was similar at each cut-off level of antenatal renal pelvic diameter from 4 to 10 mm. Neither calyceal nor ureteric dilatation was helpful in differentiating those with from those without VUR. The postnatal renal sonogram did not distinguish whether reflux was present or not. More infants with primary VUR, particularly girls, were found by changing the cut-off point for fetal renal pelvic diameter from 10 mm to 4 mm, and performing a VCUG on all such infants even if the postnatal renal sonogram was normal. Of the 33 infants with primary VUR, 9 (27%, 5 boys) had an abnormal dimercaptosuccinic acid scan. Our findings support the screening of the obstetric population for a fetal renal pelvic diameter of 4 mm or more, and then investigating the infants for VUR after birth. [ABSTRACT FROM AUTHOR]

Data reported in this issue of Pediatric Nephrology suggest that the ureteric jet Doppler waveform can predict the occurrence of vesicoureteric reflux (VUR). Many different methods are currently used to detect VUR, including traditional X-ray micturating cystourethrogram, indirect and direct nuclear imaging and contrast enhanced ultrasonography. These methods are invasive, do have some radiation burden and are also quite uncomfortable to paediatric patients. This relatively new non-invasive method is therefore of interest, but its efficacy needs to be confirmed in further studies and, in particular, in babies and infants before it can possibly be considered as a good method to provide clinical information on VUR. Once such studies have been performed, this method may also prove to be a useful approach to obtain modern knowledge on the occurrence of VUR in healthy children. [ABSTRACT FROM AUTHOR]

The American Academy of Pediatrics (AAP) recently published new guidelines on diagnosing and managing infants and children younger than 2 years who have had a febrile urinary tract infection (UTI). They recommend, as previously did the National Institute for Health and Clinical Excellence (NICE) in the UK, a marked reduction in the imaging that these children should undergo. Both NICE and AAP agree that prophylactic antibiotic treatment should not be routinely used in these children, even in those with major vesicoureteric reflux. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented about a study which investigates whether voiding cystoureterography (VCUG) is necessary for the diagnosis of vesicoureteral reflux (VUR) in infant boys with urinary tract infection (UTI).

The Society for Fetal Urology (SFU) was founded in 1988 to study the postnatal evolution of prenatally detected anomalies of the urinary tract by following those neonates whose prenatal studies have brought them to medical attention while asymptomatic. The SFU has attempted to standardize methods of performing and grading the ultrasound and radionuclide examinations in this population. A system to grade upper tract dilatation or hydronephrosis (HN) imaged by ultrasound has been developed and is being used by SFU members in 36 institutions. The appearance of the calices, renal pelvis and renal parenchyma are key in determining the grade of HN and are illustrated in this article. [ABSTRACT FROM AUTHOR]

Vesicoureteral reflux (VUR) is the greatest and most recent challenge in pediatric nephrology, with explosive and relentless growth of knowledge. Many diagnostic and therapeutic indications must be revised with regards to up-to-date discoveries on the origin and evolution of congenital anomalies of kidneys and urinary tracts (CAKUT), because prompt diagnosis and aggressive intervention often seem to have only marginal influence on remote prognosis. Diagnostic strategies must tend to minimize the number of useless studies, preferring the ones that are less invasive and which expose to the smallest radiologic risk, reminding that the target is prevention of parenchymal damage, and not detecting VUR. [ABSTRACT FROM AUTHOR]

The article offers information on urinary tract infection in children. Children with constant fever should be checked for this infection as sometimes fever is the only symptom. Children below the age of two months who are suffering from it need to be hospitalized. Children with vesicoureteral reflux are given prophylactic antimicrobials which may prevent recurring of the infection.

A letter to the editor on the topic of vesicoureteral reflux in children is presented.

In this prospective trial, Pennesi et al, randomized 100 children with vesicoureteral reflux (VUR) into a treatment arm, which received two years of oral sulfamethoxazole/ trimethoprim and a control arm that did not receive any chemoprophylaxis. Based on prior trials, a sample size of 48 was required for a 30% absolute risk difference. Analysis was done on an intention to treat basis. Children between the age of 1 day and 30 months at first episode of pyelonephritis were included. As Grade 1 would spontaneously resolve in the majority, and grade five has a high probability of being associated with renal dysplasia, only children who had grades 2-4 VUR were included. Voiding cystourethrography was performed in all, two months following the acute pyelonephritis. Renal ultrasound and DMSA scan were performed at six months. Although antibiotic prophylaxis was discontinued at two years in the intervention group, all subjects were followed up for a total period of four years. The results were quite an eye opener. Contrary to prior understanding, in the chemoprophylaxis group, there was a slightly higher risk, though not statistically significant, for developing pyelonephritis (RR 1.42 in the first year and 1.25 in the second year). 36% children in the prophylaxis group and 30% in the control group had at least one episode of pyelonephritis in the first two years. In the subsequent two years, both groups did not receive any prophylaxis. Only one in the intervention group and two in the control group developed pyelonephritis. However, it is noteworthy that all pyelonephritis episodes in the intervention arm were caused by multiresistant bacteriae, as opposed to sensitive organisms in the control group. There was no difference in the rate of renal scars or resolution of reflux between both groups. The authors conclude that antibiotic prophylaxis is ineffective either to prevent pyelonephritis recurrence, or to alter the course of the primary pathology. [ABSTRACT FROM AUTHOR]