Place of cystography through the first pyelonephritis with normal echography in childhood less than 1-year-old

Acute pyelonephritis (PNA) is the most frequent acute bacterial infection in childhood. Vesico-ureteric reflux (VUR) is a fundamental factor in the PNA's birth which gives small focal renal scars in more than 30 % in childhood. Aim.- Evaluate the contribution of cystography in the first PNA with a normal echography. Patients and methods.- We counted 99 infants aged from 2 months to 12 months old treated for a first PNA since January 2004 to December 2006 at St.-Camille Hospital (France) who benefited an echography and a cystography. Results.- Three to 6-month-old children were the most represented with 55.6 % (55/99) of the sample. The germ the most frequent was Escherichia coli with 96 % (97/99). The cystography was normal in 68.7 % (68/99) treated children. Between cystography anormal result 31.3 % (31/99), the VUR grade I and II represented more than 77 % (24/31). The evolution was based on the appearance of the PNA's repeat in 6.1 % (6/99), a total regression VUR in 54.8 % (17/31), a partial regression in 32.2 % (10/31) or an absence regression reflux in 13 % (4/31). In the preventive treatment, 6.1 % (6/99) of the children presented repeat pyelonephritis without connection with neither the existence, nor the reflux grade. Conclusion.- (a) Cystography highlights the majority of reflux which appears spontaneously or improves during months. (b) The cystography's control did not show the reflux's aggravation in our sample. (c) On account of its irradiating character, we suggest as other authors that it is not systematic in less than 1-year infants presenting a first PNA episode with a normal renal echography. (d) It is not necessary for urinary antibiotic prophylaxis in children with mild/moderate grade VUR. © 2010 Elsevier Masson SAS. All rights reserved.