6.4 References

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Evaluation and treatment of urinary tract infections in children. Am Fam Physician 1998; 57: 1573-1580, 1583-1584.

2. Alon US, Ganapathy S.

Should renal ultrasonography be done routinely in children with first urinary tract infection? Clin Pediatr Phil 1999; 38: 21-25.

3. Auringer ST.

Pediatric uroradiology update. Urol Clin North Am 1997; 24: 673-681.

4. Bitar CN, Steele RW.

Use of prophylactic antibiotics in children. Adv Pediatr Infect Dis 1995; 10: 227-262.

5. Coulthard MG, Lambert HJ, Keir MJ.

Occurrence of renal scars in children after their first referral for urinary tract infection. BMJ1997; 315: 918-919.

6. Downs SM.

Technical report: urinary tract infections in febrile infants and young children. The Urinary Tract Subcommittee of the American Academy of Pediatrics Committee on Quality Improvement. Pediatrics 1999; 103: e54.

7. Hansson S, Martinell J, Stokland E, Jodal U.

The natural history of bacteriuria in childhood. Infect Dis Clin North Am 1997; 11: 499-512.

8. Hellerstein S.

Urinary tract infections. Old and new concepts. Pediatr Clin North Am 1995; 42: 1433-1457.

9. Nuutinen M, Uhari M, Murphy MF, Hey K.

Clinical guidelines and hospital discharges of children with acute urinary tract infections. Pediatr Nephrol 1999; 13: 45-49.

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Urinary tract infections in children. Epidemiology, evaluation, and management. Pediatr Clin North Am 1997; 44: 1133-1169.

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7. REFLUX

7.1 BACKGROUND

VUR or VRR are defined as non-physiological back-flow of urine from the urinary bladder into the ureter or the renal pelvis. The worst consequence of both primary and secondary VRR is the development of progressive renal failure secondary to recurrent pyelonephritic episodes and subsequent loss of renal parenchyma.

Ten to 15% of patients with reflux suffer from a renin-dependent hypertension as a sequela of focal ischaemia due to parenchymal scarring. The probability of hypertension is highly correlated with the extent and number of parenchymal scars. Reflux is found in 0.5-1 % of normal children without UTIs. While in newborns the incidence of reflux is the same in both sexes, in later life, girls are approximately four times more frequently affected than boys.

In children with recurrent UTI, the incidence of VUR is significantly higher (about 14-29% of kindergarten and school girls and about 30% of boys of the corresponding age).

The main symptoms of VUR are recurrent and occasionally febrile UTIs. Radiological investigations verify uni- or bilateral reflux in 30-50% of cases. A VRR may also make itself apparent in later stages by its consequences, such as hypertension, renal insufficiency or delayed renal growth. Undetected reflux may lead to reflux nephropathy.