The inspection about the long-term management of the initial acute pyelonephritis

Objective: The aim of this study is to validate preventive medication and radiological examinations in management of children with pyelonephritis. Methods and Results: The medical records of one hundred sixty four patients (121 males and 43 females) were reviewed retrospectively. They were managed according to the Practice Parameter recommended by the American Academy of Pediatrics. Voiding cystourethrography were inspected after the first pyelonephritis. In nine of 32 patients (28%) without vesicoureteral reflux (VUR) who had no preventive medication, pyelonephritis relapsed. While a recurrence was observed in 2 of 15 patients (13%) with the grade I to III of VUR and in 5 of 10 patients (50%) with the grade IV and V of VUR who had preventive medication. The VUR detection rate of DMSA scintigraphy in patients with the degree III-V of VUR remained at 73% (8 of 11 patients). DMSA scintigraphy showed the defect even in 6 of 15 patients who received medication within 24 hours after onset of fever. The grade of VUR was improved from over III to under I in 7 of 11 infants. Conclusions:Effectiveness of prophylaxis was uncertain in this study. However, there are some infants with high grade VUR who showed an improving trend. So, prophylaxis seemed usefull in such patients. DMSA scintigraphy was not an alternative to VCUG in acute phase. There seemed to be no inevitability of changing the Practice Parameter from our data. Large-scale research would be needed considering the age and the degree of reflux.