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Editorial Opinion 3-5 more sinister names: covert bacteriuria, pyelonephritis lenta. abnormalrenal-bladderultrasonogram(RBUS). Thisapproach Theideawasthatundetected,smolderinginfectionwasprogres- has been challenged, largely because of the low sensitivity of 6 1 sively damaging the kidneys of children, leading to impaired re- RBUS to identify VUR with RBUS. Shaikh et al shift the focus nal function by early adulthood. By the late 1970s, the current from VUR to renal scarring and confirm the value of the RBUS as understanding of asymptom- apredictorofrenaldamage.Highfeverandorganismsotherthan aticbacteriuriahademergedas Escherichia coli are also predictors, but notably, adding a VCUG Related article page 893 a familial condition, predomi- and serum inflammatory markers to the evaluation contributes nantly in white females, that, very little. Shaikh et al evaluated 3 models; model 1 includes the left untreated, is benign except during pregnancy. As the con- 3 factors (RBUS, high fever, and organism other thanEcoli), in- cept of asymptomatic bacteriuria as a cause of renal damage was formation clinicians treating infants and children with UTI are fading, however, concern had taken hold that vesicoureteral re- likely to have, and could be used to predict 45% of those who flux (VUR) was a major mechanism for renal damage by back- would incur scarring. As expected, the presence
JAMA Pediatrics – American Medical Association
Published: Oct 1, 2014
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