The long-term consequences of urinary tract infections: a historic and contemporary perspective

Area of Science:

• Pediatric Nephrology
• Urology

Background:

• Childhood urinary tract infections (UTIs) can lead to severe long-term health issues, including hypertension, impaired renal function, and end-stage renal disease.
• These adverse outcomes are primarily caused by renal parenchymal damage, often stemming from congenital abnormalities or acquired injury.

Purpose of the Study:

• To review the long-term consequences of childhood UTIs, focusing on renal parenchymal damage and associated conditions.
• To highlight the significance of vesicoureteral reflux (VUR) as a common factor in pediatric UTIs and its spectrum of underlying causes.

Main Methods:

• Literature review of studies on childhood UTIs and their long-term sequelae.
• Analysis of the relationship between VUR, voiding dysfunction, congenital abnormalities, and renal damage.

Main Results:

• Childhood UTIs can result in hypertension, impaired renal function, end-stage renal disease, and pregnancy complications, particularly when renal parenchymal damage occurs.
• Vesicoureteral reflux (VUR) is the most frequent abnormality in infants and children with UTIs, representing a range of underlying conditions from nonobstructive VUR to severe hydronephrosis and intrauterine renal damage.
• Children with intrauterine renal damage are at the highest risk for developing hypertension and progressing to end-stage renal disease.

Conclusions:

• Preventing renal parenchymal damage from childhood UTIs is essential to avoid long-term adverse health consequences.
• Understanding the spectrum of conditions associated with VUR is critical for risk stratification and management of children with UTIs.
• While acquired renal injury from UTIs is less common now due to improved healthcare, congenital factors and intrauterine damage remain significant risk factors for severe outcomes.