[Urinary infection and reflux nephropathy in children]

Abstract

Urinary tract infection (UTI) is relatively frequent in children. The symptoms are often atypical; the more so, the younger the child. UTI is often associated with functional or malformative uropathy, such as vesico-ureteral reflux or obstruction. Radiological investigation should be carried out in every child presenting with his first UTI. The prognosis of uncomplicated UTI is good, but is less favorable when UTI is associated with urological abnormalities. Development of pyelonephritic lesions can lead to kidney scarring for which the occurrence of intrarenal reflux, associated with a specific type of papilla, is probably responsible. Short-term treatment is recommended for uncomplicated UTI. Uncomplicated UTI with frequent relapses, or UTI associated with vesio-ureteral reflux, requires prophylactic chemotherapy. Worsening of reflux and/or the development of pyelonephritic lesions while on prophylactic treatment are an indication for surgical intervention. Surgery is always indicated in the presence of a major urological malformation. Be it medical or surgical, treatment of UTI should always be followed by regular urine cultures for several years.