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Published on: June 23, 2015
Long-term follow-up of patients after childhood urinary tract infection
Annukka Hannula1, Marja Perhomaa, Mika Venhola
1Department of Pediatrics, University of Oulu, Oulu, Finland. annukka.hannula@oulu.fi
Insights
Long-term outcomes for children with urinary tract infection (UTI) show a very low risk of serious consequences. Follow-up revealed minimal renal scarring or growth issues, with normal kidney function and blood pressure in most cases.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Urology
Background:
- Urinary tract infections (UTIs) are common in children.
- Long-term renal sequelae after childhood UTI are a concern.
- Previous studies have shown varying outcomes.
Purpose of the Study:
- To evaluate the long-term renal and functional outcomes in children following a UTI.
- To assess the incidence of renal parenchymal defects and growth disturbances.
- To determine the impact of childhood UTI on kidney function and blood pressure over time.
Main Methods:
- A cohort of 1161 children with a history of UTI was established.
- A stratified random sample of 193 patients underwent follow-up examinations 6-17 years post-UTI.
- Outcomes assessed included renal ultrasonography, kidney function tests, and blood pressure measurements.
Main Results:
- Unilateral renal parenchymal defects were observed in 15% of patients, primarily associated with high-grade vesicoureteral reflux.
- Kidney growth retardation was noted in 3% of patients.
- Despite observed defects, all patients maintained normal serum cystatin C, estimated glomerular filtration rate, and blood pressure.
Conclusions:
- The risk of significant long-term renal consequences following childhood UTI appears low.
- Observed renal parenchymal defects did not translate to impaired kidney function or hypertension.
- Further research is needed to confirm these findings, considering the observational nature of the study and potential treatment effects.
Objective:
To evaluate the long-term outcome of children with urinary tract infection (UTI).
Design:
Follow-up examination 6 to 17 years after childhood UTI.
Setting:
Secondary to tertiary referral center.
Patients:
From an original population-based cohort of 1185 children with a history of UTI on whom both ultrasonography (US) and voiding cystourethrography had been performed between January 1, 1993, and December 31, 2003, we excluded 24 cases with major renal dysplasia or obstruction of the urinary tract to form a study cohort of 1161 patients. We took a stratified random sample of 228 patients for follow-up, and a total of 193 (85%) participated. Of the 193 participating patients, 103 (53%) had received antibiotic prophylaxis and 42 (22%) had undergone surgery.
Main Exposure:
Urinary tract infection.
Main Outcome Measures:
Renal growth and parenchymal damage in US examination, kidney function, and blood pressure.
Results:
Unilateral renal parenchymal defect was found in 22 of the 150 patients (15%) studied with US at follow-up, and unilateral kidney growth retardation was found in 5 patients (3%). All but 1 of the renal parenchymal defects seen on US were in patients with grade III to V vesicoureteral reflux. Despite the parenchymal defects seen on US, the serum cystatin C concentration, estimated glomerular filtration rate, and blood pressure were within the normal ranges in all patients.
Conclusions:
The risk of long-term consequences from childhood UTI seems to be very low. Owing to the observational nature of our study, we cannot exclude the effects of the given treatment on the outcome of our patients.
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