J Urol: Why does preventing recurrent urinary tract infections not lead to fewer kidney scars?

The RIVUR (Random Intervention in Children with Bladder Urethra Reflux) reported that antibiotic prevention reduced recurrent urinary tract infections, but antibiotic prevention was not related to a reduction in new kidney scarringHowever, the initial reports did not examine in detail the relationship between recurrent urinary tract infections, new kidney scarring and antibiotic preventionSo we investigated the relationship between these issueswe included subjects who had a dicaron amber acid scan within 6 months of entering the group, and at least one follow-up dicarnate acid scan in the RIVUR trialThe main outcome is new kidney scars associated with recurrent urinary tract infections, defined as new changes in recurrent urinary tract infections and dicarate amber acid scansBecause of the small number of events, tendentious scoring is used to adjust the confounding factorsMultivariate logistic regression fitting to study the association between covariates and resultsresults, a total of 489 patients (91 per cent female, with an average age of 20.3 months) were included in the studyNew kidney scarring is more common in patients with recurrent urinary tract infections (OR 4.1, 95% CI 2.0-8.5, p 0.01), and new kidney scars are more common in patients with recurrent urinary tract infections after age, sex, exponential urinary tract infections, replication, bladder dysfunction, and antibiotic preventionNew kidney scars associated with recurrent urinary tract infections occurred in 5 (2%) of 244 patients with antibiotic prophylaxis and 13 (5%) of 245 placebo patientsCompared to preventive treatment with antibiotics, placebo scar risk associated with recurrent urinary tract infections is higher (OR 3.1, 95% CI 1.0-8.8, p-0.04), and the risk of relapse in relapse in relapse renal tract disease scanoe after age, sex, race, exponential urinary tract infection, bladder dysfunction, replication, hydration of kidneys, and baseline scar- and relapseThere was no difference between the scar severity (P-0.88) at the final dimethyl uric acid scan between the antibiotic prophylaxis and the placebo or the change in baseline (P-0.53), the results show that recurrent urinary tract infections are associated with new kidney scarring in RIVUR trialsAntibiotic prevention is associated with a reduced risk of this result when a recurrent urinary tract infection is limited to a new kidney scarIt is not clear why new kidney scars form in subjects without recurrent urinary tract infectionsDue to inherent limitations, these results should be carefully interpreted