To the Editor.

We read with interest the study by Hewitt et al on the effect of early treatment on the development of renal scarring in children with acute pyelonephritis. They found that early treatment of acute pyelonephritis had no significant effect on the incidence of subsequent renal scarring and, therefore, found it “possible to advise a less-urgent approach for children with fever who appear otherwise well, even if there is a risk of recurrent UTI [urinary tract infection].”

In a previous study that involved 158 consecutive children with a first episode of symptomatic UTI, we found that a delay in the start of treatment was an independent risk factor for the development of uptake defects in dimercaptosuccinic acid scintigraphy performed in the acute phase of an episode of UTI (relative risk: 1.8 [95% confidence interval: 1.34–2.41]). Doganis et al also showed that renal defects in...

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