{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T13:29:47Z","timestamp":1790602187043,"version":"4.1.0"},"reference-count":27,"publisher":"American Academy of Pediatrics (AAP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2008,9,1]]},"abstract":"<jats:p>OBJECTIVES. The American Academy of Pediatrics recommendation for febrile infants and young children suspected of having a urinary tract infection is early antibiotic treatment, given parenterally if necessary. In support of this recommendation, data suggesting that delay in treatment of acute pyelonephritis increases the risk of kidney damage are cited. Because the risk was not well defined, we investigated renal scarring associated with delayed versus early treatment of acute pyelonephritis in children.<\/jats:p>\n                  <jats:p>METHODS. The research findings are derived from 2 multicenter, prospective, randomized, controlled studies, Italian Renal Infection Study 1 and 2, whose primary outcomes dealt with initial antibiotic treatment and subsequent prophylaxis, respectively. From the 2 studies, we selected the 287 children with confirmed pyelonephritis on acute technetium-99m-dimercaptosuccinic acid scans who underwent repeat scanning to detect scarring 12 months later. The children were 1 month to &amp;lt;7 years of age when they presented with their first recognized episode of acute pyelonephritis in northeast Italy.<\/jats:p>\n                  <jats:p>RESULTS. Progressive delay in antibiotic treatment of acute pyelonephritis from &amp;lt;1 to \u22655 days after the onset of fever was not associated with any significant increase in the risk of scarring on technetium-99m-dimercaptosuccinic acid scans obtained 1 year later. The risk of scarring remained relatively constant at 30.7 \u00b1 7%. Clinical and laboratory indices of inflammation were comparable in all groups, as was the incidence of vesicoureteric reflux.<\/jats:p>\n                  <jats:p>CONCLUSIONS. Early treatment of acute pyelonephritis in infants and young children had no significant effect on the incidence of subsequent renal scarring. Furthermore, there was no significant difference in the rate of scarring after acute pyelonephritis when infants and young children were compared with older children.<\/jats:p>","DOI":"10.1542\/peds.2007-2894","type":"journal-article","created":{"date-parts":[[2008,9,1]],"date-time":"2008-09-01T09:27:57Z","timestamp":1220261277000},"page":"486-490","source":"Crossref","is-referenced-by-count":125,"title":["Early Treatment of Acute Pyelonephritis in Children Fails to Reduce Renal Scarring: Data From the Italian Renal Infection Study Trials"],"prefix":"10.1542","volume":"122","author":[{"given":"Ian K.","family":"Hewitt","sequence":"first","affiliation":[{"name":"Department of Pediatric Nephrology, Princess Margaret Hospital, Perth, Australia; Departments of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Zucchetta","sequence":"additional","affiliation":[{"name":"Nuclear Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Rigon","sequence":"additional","affiliation":[{"name":"Pediatric Unit, Camposampiero Hospital, Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Maschio","sequence":"additional","affiliation":[{"name":"Pediatric Unit, Mestre Hospital, Mestre, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pier Paolo","family":"Molinari","sequence":"additional","affiliation":[{"name":"Pediatric Unit, Bologna General Hospital, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisanna","family":"Tomasi","sequence":"additional","affiliation":[{"name":"Pediatric Nephrology, Azienda Ospedaliera-University of Padua, Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonella","family":"Toffolo","sequence":"additional","affiliation":[{"name":"Pediatric Unit, Motta di Livenza Hospital, Livenza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi","family":"Pavanello","sequence":"additional","affiliation":[{"name":"Pediatric Unit, Castelfranco Hospital, Castelfranco, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Crivellaro","sequence":"additional","affiliation":[{"name":"Pediatric Unit, Chioggia Hospital, Chioggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Bellato","sequence":"additional","affiliation":[{"name":"Pediatric Unit, Arzignano Hospital, Arzignano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Montini","sequence":"additional","affiliation":[{"name":"Pediatric Nephrology, Azienda Ospedaliera-University of Padua, Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2008,9,1]]},"reference":[{"key":"2021120905243790200_R1","doi-asserted-by":"crossref","unstructured":"Jakobsson B, Berg U, Svensson L. Renal scarring after acute pyelonephritis. Arch Dis Child.\u20081994;70(2):111\u2013115","DOI":"10.1136\/adc.70.2.111"},{"key":"2021120905243790200_R2","doi-asserted-by":"crossref","unstructured":"Stokland E, Hellstrom M, Jacobsson B, et al. Renal damage one year after first urinary tract infection: role of dimercaptosuccinic acid scintigraphy. J Pediatr.\u20081996;129(6):815\u2013820","DOI":"10.1016\/S0022-3476(96)70024-0"},{"key":"2021120905243790200_R3","doi-asserted-by":"crossref","unstructured":"Benador D, Benador N, Slosman D, Mermillod B, Girardin E. Are younger children at highest risk of renal sequelae after pyelonephritis?Lancet.\u20081997;349(9044):17\u201319","DOI":"10.1016\/S0140-6736(96)06126-0"},{"key":"2021120905243790200_R4","doi-asserted-by":"crossref","unstructured":"Wald E. Urinary tract infections in infants and children: a comprehensive overview. Curr Opin Pediatr.\u20082004;16(1):85\u201388","DOI":"10.1097\/00008480-200402000-00016"},{"key":"2021120905243790200_R5","doi-asserted-by":"crossref","unstructured":"Schlager TA. Urinary tract infections in children younger than 5 years of age: epidemiology, diagnosis, treatment, outcomes and prevention. Paediatr Drugs.\u20082001;3(3):219\u2013227","DOI":"10.2165\/00128072-200103030-00004"},{"key":"2021120905243790200_R6","doi-asserted-by":"crossref","unstructured":"American Academy of Pediatrics: Practice parameter: the diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. Pediatrics.\u20081999;103(4):843\u2013852","DOI":"10.1542\/peds.103.4.843"},{"key":"2021120905243790200_R7","doi-asserted-by":"crossref","unstructured":"Winter AL, Hardy BE, Alton DJ, Arbus GS, Churchill BM. Acquired renal scars in children. J Urol.\u20081983;129(6):1190\u20131194","DOI":"10.1016\/S0022-5347(17)52634-8"},{"key":"2021120905243790200_R8","doi-asserted-by":"crossref","unstructured":"Smellie JM, Poulton A, Prescod NP. Retrospective study of children with renal scarring associated with reflux and urinary infection. BMJ.\u20081994;308(6938):1193\u20131196","DOI":"10.1136\/bmj.308.6938.1193"},{"key":"2021120905243790200_R9","doi-asserted-by":"crossref","unstructured":"Montini G, Toffolo A, Zucchetta P, et al. The IRIS 1 study of antibiotic treatment of pyelonephritis in children: a multicenter randomized controlled non-inferiority trial. BMJ.\u20082007;335(7616):386\u2013388","DOI":"10.1136\/bmj.39244.692442.55"},{"key":"2021120905243790200_R10","unstructured":"Montini G, Rigon L, Zucchetta P, et al. Prophylaxis after first febrile urinary tract infection in children? A multicenter, randomized, controlled, noninferiority trial. 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