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Acute renal damage in infants after first urinary tract infection
Salvatore Cascio1, Boris Chertin, Akihiro Yoneda
1Children's Research Centre, Our Lady's Hospital for Sick Children, Crumlin, Dublin 12, Ireland.
Insights
Urinary tract infections (UTIs) are common in newborns. This study found 35% of infants with a first UTI had urinary tract abnormalities, recommending routine imaging for early detection and management.
Area of Science:
- Pediatric Nephrology
- Neonatal Medicine
- Infectious Diseases
Background:
- Urinary tract infection (UTI) is a frequent cause of unexplained fever in neonates.
- Early diagnosis and management are crucial to prevent renal damage.
Purpose of the Study:
- To determine the incidence of urinary tract anomalies and acute renal damage in neonates with their first UTI.
- To evaluate the necessity of specific diagnostic imaging after a neonatal UTI.
Main Methods:
- Retrospective review of 57 neonates diagnosed with UTI within the first 8 weeks of life.
- All patients underwent renal ultrasonography (US), voiding cystourethrogram (VCUG), and technetium-99m dimercaptosuccinic acid (DMSA) scan.
- Exclusion of patients with antenatal hydronephrosis or incomplete investigations.
Main Results:
- Urinary tract abnormalities were detected in 35% of neonates.
- Vesicoureteral reflux (VUR) was identified in 33% of infants.
- Acute renal cortical defects were observed in kidneys with and without VUR.
Conclusions:
- A significant proportion of neonates with a first UTI exhibit urinary tract abnormalities.
- Routine renal ultrasonography, VCUG, and DMSA scan are recommended after the first UTI in infants under 8 weeks.
- Prompt imaging can aid in identifying conditions like VUR and renal damage.
Abstract:
Urinary tract infection (UTI) is one of the most common causes of unexplained fever in neonates. The aim of this study was to determine the incidence of urinary tract anomalies and acute renal damage in neonates who presented with first urinary tract infection in the first 8 weeks of life. We reviewed the records of 95 infants, who were hospitalised with UTI during a 6-year period (1994-1999). Patients with antenatally diagnosed hydronephrosis and incomplete radiological investigations were excluded from the study. Of the remaining 57 patients, 42 were boys and 15 girls. The mean age at diagnosis was 32 days (range 5-60 days). All patients underwent renal ultrasonography (US), voiding cystourethrogram (VCUG) and (99m)Tc-dimercaptosuccinic acid (DMSA) scan. Urinary tract abnormalities were detected in 20 (35%) patients. Vesicoureteral reflux (VUR) was found in 19 (33%) neonates, 7 girls and 12 boys. Acute cortical defects on DMSA scan were present in 19 kidneys of patients with VUR and in 25 of those without reflux. Only one-third of neonates after first symptomatic UTI had VUR. We recommend that US, VCUG, and DMSA scan should be routinely performed after the first UTI in infants younger than 8 weeks.