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Renal function 16 to 26 years after the first urinary tract infection in childhood
M Wennerström1, S Hansson, U Jodal
1Department of Pediatrics, Sahlgrenska University Hospital/East, Göteborg, Sweden. martin.wennerstroem@swipnet.se
Insights
Renal function in individuals with childhood urinary tract infection (UTI) and renal scarring was well-preserved two decades later. However, scarred kidneys showed declining individual glomerular filtration rate (GFR), suggesting a need for continued monitoring.
Area of Science:
- Pediatric Nephrology
- Urology
- Renal Function Assessment
Background:
- Childhood urinary tract infections (UTIs) can lead to renal scarring.
- Long-term effects of renal scarring on kidney function are not fully understood.
Purpose of the Study:
- To evaluate long-term renal function in adults who had renal scarring after a childhood UTI.
- To compare kidney function between individuals with and without renal scarring.
Main Methods:
- A population-based cohort study followed individuals 16-26 years after their first UTI.
- Glomerular filtration rate (GFR) was measured using chromium 51-EDTA clearance.
- Participants included those with nonobstructive renal scarring and matched controls without scarring.
Main Results:
- Overall GFR was similar between scarred and non-scarred groups (median 99 ml/min/1.73 m²).
- Individual GFR in unilaterally scarred kidneys declined significantly over time.
- GFR was significantly lower in the bilateral scarring group compared to the unilateral scarring group at follow-up.
Conclusions:
- Kidney function is generally well-preserved two decades after childhood UTI, even with scarring.
- A decline in individual renal GFR of scarred kidneys necessitates ongoing surveillance.
- Individuals with bilateral renal scarring may face a more severe long-term prognosis.
Objective:
To evaluate renal function in a population-based cohort with urographic renal scarring after childhood urinary tract infection (UTI).
Design:
Follow-up investigation 16 to 26 years after the first recognized UTI.
Setting:
Outpatient university clinic for children with UTI serving the local area.
Patients:
From the original cohort of 1221 consecutive children with first UTI diagnosed during 1970 to 1979, 57 (41 females and 16 males; mean age, 24.5 years) of 68 with nonobstructive renal scarring participated as well as 51 (38 females and 13 males; mean age, 24.9 years) matched subjects without scarring.
Main Outcome Measure:
Glomerular filtration rate (GFR) measured by chromium 51-EDTA clearance, expressed as milliliters per minute per 1.73 square meters.
Results:
Median GFR was 99 in both those with and without renal scarring. In patients with unilateral scarring, the total GFR remained unchanged over the years whereas the individual GFR of the scarred kidneys declined significantly from 46 to 39. In 7 patients with bilateral scarring, the GFR declined from 94 to 84 (P = .14); compared with those with unilateral scarring, the GFR was significantly lower at follow-up (P = .007). Median urinary albumin-creatinine ratio was 1.2 and 0.6 mg/mmol in those with scarring and those without, respectively (P = .30).
Conclusions:
The GFR 2 decades after the first recognized UTI in childhood was well preserved. However, a significant reduction of individual renal GFR in the unilaterally scarred kidneys indicates that further follow-up is required. Although there were few patients with bilateral scarring, a more serious prognosis can be expected among them.