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Children with VUR have an increased risk of contracting a febrile urinary tract infection (UTI). Febrile UTIs may cause a renal scar, with the degree of renal damage being affected by a complex interaction of host defence mechanisms and bacterial virulence factors. However, not all renal parenchymal damages in children with VUR are infectious in origin. Renal scars seen in boys are mainly congenital dysplasia, associated with high grade VUR, and recurrent urinary tract infections are rare in boys. Girls have more frequently recurrent UTIs and their renal parenchymal damages are more often post-infection scars. New scars are mostly seen in children under 5 years of age and more frequently in children with high grade VUR. Continuous antibiotic prophylaxis (CAP) has routinely been used in children with VUR to prevent recurrent UTIs and possibly also post-infectious scars. Its’ effectiveness has been questioned after several RCTs and meta-analyses that have failed to reveal the efficacy of CAP in reducing the risk of renal scarring. This chapter aims to describe the current knowledge regarding the risk of renal scarring in children with VUR and ongoing treatment with antibiotic prophylaxis.

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New Renal Parenchymal Damage Following Breakthrough Urinary Tract Infection in Patients Treated with Antibiotic Prophylaxis

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  • 发表日期：

    2025年

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  • Josefin Nordenström,
  • Per Brandström,
  • Yvonne Simrén

摘要

Children with VUR have an increased risk of contracting a febrile urinary tract infection (UTI). Febrile UTIs may cause a renal scar, with the degree of renal damage being affected by a complex interaction of host defence mechanisms and bacterial virulence factors. However, not all renal parenchymal damages in children with VUR are infectious in origin. Renal scars seen in boys are mainly congenital dysplasia, associated with high grade VUR, and recurrent urinary tract infections are rare in boys. Girls have more frequently recurrent UTIs and their renal parenchymal damages are more often post-infection scars. New scars are mostly seen in children under 5 years of age and more frequently in children with high grade VUR. Continuous antibiotic prophylaxis (CAP) has routinely been used in children with VUR to prevent recurrent UTIs and possibly also post-infectious scars. Its’ effectiveness has been questioned after several RCTs and meta-analyses that have failed to reveal the efficacy of CAP in reducing the risk of renal scarring. This chapter aims to describe the current knowledge regarding the risk of renal scarring in children with VUR and ongoing treatment with antibiotic prophylaxis.