Paediatric Nephrology Unit, Great North Children's Hospital, , Newcastle, UK.
Arch Dis Child. 2014 Apr;99(4):342-7. doi: 10.1136/archdischild-2013-304428. Epub 2013 Dec 18.
To test whether active management of urinary tract infections (UTI) in young children by general practitioners can reduce kidney scarring rates.
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).
Kidney scarring rates, and their relationship with time-to-treat.
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).
Most kidney defects seen in children after UTIs, are acquired scars, and in Newcastle, active management in primary care has halved this rate.
检验基层医生积极管理小儿尿路感染（UTI）是否能降低肾瘢痕形成率。
对纽卡斯尔市两组小儿尿路感染患儿（年龄<8 岁）进行比较，一组为常规管理的回顾性研究（20 世纪 90 年代），一组为直接进入管理的前瞻性研究（21 世纪 00 年代）。
肾脏瘢痕形成率及其与治疗时间的关系。
21 世纪的初诊患儿比 20 世纪 90 年代的患儿就诊年龄更早，患肾瘢痕的风险降低一半（女孩 OR0.47，95%CI0.29 至 0.76；男孩 OR0.35，0.16 至 0.81），且约 12 倍更可能发生无瘢痕性输尿管反流（女孩 11.9，4.3 至 33.5；男孩 14.4，4.3 至 47.6）。21 世纪基层医生在初诊时治疗了约一半的患儿。症状开始后 3 天内治疗的患儿发生瘢痕的风险是症状持续时间较长患儿的三分之一（OR0.33，0.12 至 0.72）。
在纽卡斯尔，初级保健中积极管理使小儿尿路感染后的大多数肾脏缺陷（获得性瘢痕）减半。
