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Does prompt treatment of urinary tract infection in preschool children prevent renal scarring: mixed retrospective and prospective audits

Lookup NU author(s): Dr Malcolm Coulthard, Dr Heather Lambert, Dr Sue Vernon, Dr Michael Keir, Professor John MatthewsORCiD



This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


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.

Publication metadata

Author(s): Coulthard MG, Lambert HJ, Vernon SJ, Hunter EW, Keir MJ, Matthews JNS

Publication type: Article

Publication status: Published

Journal: Archives of Disease in Childhood

Year: 2014

Volume: 99

Issue: 4

Pages: 342-347

Print publication date: 01/04/2014

Online publication date: 18/12/2013

Acceptance date: 01/12/2013

Date deposited: 21/05/2014

ISSN (print): 0003-9888

ISSN (electronic): 1468-2044

Publisher: BMJ Publishing Group


DOI: 10.1136/archdischild-2013-304428


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