In this retrospective study the authors confirm a previously reported finding, that children with an abnormal renal scan are at risk for breakthrough infection (reference 5 in article). Although not novel, this work is important in narrowing the research focus, hopefully leading to the design of future prospective studies.Selection bias probably explains several of the inconsistencies in this study. For proper interpretation of renal scarring there must be a well-defined nomenclature. In this study there is no defined grading system and thus, for example, no definition of what constitutes a small kidney. The authors do not clearly describe how cases were selected, except to say that the severest cases were referred to them.
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