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Management of children with urinary tract infections: the Stanford experience
Insights
Children with urinary tract infections (UTIs) and ureteral reflux face renal damage risk. Surgical correction of reflux did not alter infection rates but improved infection type. Early detection and management are crucial.
Area of Science:
- Pediatric Urology
- Infectious Diseases
- Nephrology
Background:
- Recurrent urinary tract infections (UTIs) are common in female children.
- Ureteral reflux is a significant risk factor for renal damage in pediatric UTIs.
- The long-term impact of ureteral reflux and its management on renal health requires further investigation.
Purpose of the Study:
- To evaluate the impact of ureteral reflux on infection rates and renal damage in female children.
- To compare the outcomes of surgical correction versus medical management for ureteral reflux.
- To assess the relationship between the degree of reflux and the incidence of renal scarring.
Main Methods:
- Retrospective evaluation of 278 female children with UTIs over a minimum 12-month follow-up.
- Categorization into groups: no ureteral reflux, ureteral reflux with surgical correction, and ureteral reflux with medical management.
- Radiological assessment of renal units for clubbing and scarring, correlating with reflux severity and treatment.
Main Results:
- Children with ureteral reflux had a higher incidence of clinical pyelonephritis but similar overall infection rates compared to non-refluxing children.
- Surgical correction of ureteral reflux did not alter infection rates but changed the nature of infections.
- Renal scarring and clubbing were more prevalent in refluxing kidneys, with progression observed even after surgical correction in some cases; higher reflux degree correlated with greater renal damage.
Conclusions:
- Children with recurrent UTIs without ureteral reflux are at low renal risk.
- Children with ureteral reflux are at risk for renal damage unless infections are controlled or reflux is surgically corrected.
- The degree of ureteral reflux is a critical factor influencing the risk and progression of renal damage.
Abstract:
Two hundred seventy-eight female children with urinary tract infections have been evaluated at Stanford division of urology. All children were followed up for a period of not less than twelve months. Age of onset of infection, clinical presentation, and nature of infecting organisms were observed. The group consisted of 144 children without ureteral reflux and 134 children with ureteral reflux. Sixty-one of the female children with ureteral reflux had ureteral reimplantation, while 73 received medical treatment alone. A study of infection rates in each of the three groups of children indicated a similar infection rate, although those children with reflux experienced a higher incidence of clinical pyelonephritis. Correction of ureteral reflux did not alter the infection rate; however, infections after surgical correction were generally of a type usually associated with children without reflux. Twenty-nine children had urethral dilatation, and the infection rate prior to and following urethral dilatation indicated a similar rate of infection pre- and posturethral dilatation. One hundred nonrefluxing kidneys were observed radiologically: 97 were normal and 3 showed clubbing and scarring. Of 110 refluxing renal units observed, 62 were clubbed and scarred and 48 were normal. Following surgical correction of reflux, renal clubbing and scarring were not observed in previously normal renal units. Of those renal units found to be abnormal at time of surgery, 66 per cent showed progression of clubbing and scarring after surgical correction of reflux. It was observed that the greater the degree of reflux present, the higher the incidence of renal damage. This study suggests that children who experience recurrent urinary tract infections who do not have ureteral reflux are seldom at renal risk; similar children who do have ureteral reflux are at risk unless the infections are controlled or the reflux either disappears or is corrected surgically.