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Childhood urinary tract infections as a cause of chronic kidney disease
Jarmo Salo1, Risto Ikäheimo, Terhi Tapiainen
1Department of Pediatrics, Institute of Clinical Medicine, Faculty of Medicine, University of Oulu, Oulu, Finland. jarmo.salo@oulu.fi
Insights
Childhood urinary tract infections (UTIs) rarely cause chronic kidney disease (CKD). In children with normal kidney imaging after a UTI, the risk of developing CKD is very low.
Area of Science:
- Pediatric Nephrology
- Epidemiology of Kidney Disease
Background:
- Childhood urinary tract infections (UTIs) are a suspected risk factor for developing chronic kidney disease (CKD).
- However, the causal link and the proportion of CKD cases attributable to childhood UTIs remain poorly understood and require further investigation.
Purpose of the Study:
- To determine the etiologic fraction of childhood UTIs as a cause of chronic kidney disease (CKD).
- To assess the risk of CKD in children following UTIs, particularly in the absence of apparent kidney abnormalities.
Main Methods:
- A systematic literature search was performed to identify studies associating childhood UTIs with CKD.
- Data from patients diagnosed with CKD at a tertiary care hospital were retrospectively reviewed.
Main Results:
- No cases in a literature review of 1576 patients identified childhood UTIs as the primary cause of CKD.
- Among 58 CKD patients without a specific noninfectious cause, 13 had a history of childhood UTIs; all showed kidney abnormalities on initial imaging.
- Recurrent UTIs were the likely cause of CKD in one patient, suggesting a maximum etiologic fraction of 0.3% for recurrent childhood UTIs.
Conclusions:
- The risk of developing chronic kidney disease (CKD) from childhood urinary tract infections (UTIs) appears minimal, especially when initial kidney imaging reveals no structural abnormalities.
- Children with normal kidney structure after a UTI are unlikely to develop significant kidney disease later in life.
Objective:
Urinary tract infections (UTIs) in childhood are considered a risk for chronic kidney disease (CKD), but this association is poorly verified. We wanted to determine the etiologic fraction of UTIs in childhood as a cause of CKD.
Methods:
A systematic literature search on the association between childhood UTIs and CKD was conducted, and data for patients with CKD in the area of 1 tertiary care hospital were reviewed.
Results:
In our literature search, we found no patients among the 1576 reviewed cases for whom childhood UTIs were the main cause of subsequent CKD. However, there were 3 patients with childhood UTIs for whom the results of kidney imaging studies were not reported. Of the 366 patients with CKD who were monitored in the Oulu University Hospital, 308 had a specific noninfectious cause of CKD. Of the remaining 58 patients, 13 had a history of UTIs in childhood. In their first imaging studies, all of those 13 patients demonstrated kidney tissue abnormalities, which could have been observed through ultrasonography. Recurrent UTIs in childhood were possibly the cause of CKD in 1 case; therefore, the etiologic fraction of recurrent childhood UTIs as a main cause of CKD was, at most, 0.3%.
Conclusions:
In the absence of structural kidney abnormalities evident in imaging studies after the first childhood UTI, the etiologic fraction of recurrent childhood UTIs as a main cause of CKD seems to be small. A child with normal kidneys is not at significant risk of developing CKD because of UTIs.
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