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Guidelines for urinary tract infections and antenatal hydronephrosis should be gender specific
Shiran S Moore1,2, Hilla Bahat2,3, Mariana Rachmiel2,3
1Department of Paediatrics, Meir Medical Centre, Kfar Saba, Israel.
Insights
Female infants face a higher risk of febrile urinary tract infections (UTIs). This finding is crucial for developing gender-specific clinical guidelines for UTI and antenatal hydronephrosis (ANH) assessment in children.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Urology
Background:
- Febrile urinary tract infections (UTIs) in infants can lead to long-term kidney damage.
- Voiding cystourethrography (VCUG) is often used to assess children with antenatal hydronephrosis (ANH) or after a febrile UTI.
Purpose of the Study:
- To identify risk factors for future UTIs in children undergoing VCUG for ANH assessment or post-febrile UTI.
- To determine if the risk of recurrent UTIs differs based on the indication for VCUG.
Main Methods:
- A cohort study analyzed medical records of 285 children aged 0-24 months who underwent VCUG between 2004-2011.
- Follow-up data for at least six months was used to assess the incidence of future UTIs.
Main Results:
- The incidence of UTIs was 12.5% after a primary UTI and 5.5% after ANH (p=0.049).
- Multivariate analysis revealed no significant difference in UTI risk between the ANH and primary UTI groups.
- Female infants demonstrated a significantly higher risk of febrile UTIs (HR 3.3, p=0.04), irrespective of VUR status.
Conclusions:
- Female infants are at a higher risk for febrile UTIs, independent of VUR, ANH, or prior UTI history.
- Current clinical guidelines for UTI and ANH assessment may need to incorporate gender-specific considerations.
Aim:
Febrile urinary tract infections (UTIs) may be associated with long-term renal damage. Our goal was to identify risk factors for future UTIs in children who had voiding cystourethrography (VCUG) as a part of an antenatal hydronephrosis (ANH) assessment or after a febrile UTI.
Methods:
We conducted a cohort study based on the medical records of children aged 0-24 months who underwent a VCUG between January 2004 and December 2011 and had at least six months of follow-up. The incidence of future UTIs was assessed.
Results:
We included 285 children: 176 had a primary UTI and 109 had ANH. We recorded 28 UTIs during the follow-up period, and the risk was 12.5% after a primary UTI and 5.5% after an ANH (p = 0.049). Multivariate analysis showed no risk difference was found between the groups. Females had a greater risk of febrile UTIs (hazard ratio 3.3, 95% confidence interval 1.03-9.2, p = 0.04), but the UTI risk did not differ between children with or without VURs.
Conclusion:
Female infants were at greater risk of febrile UTIs, regardless of the presence of VUR, VUR degree, ANH or a previous UTI. Clinical guidelines for UTI and ANH assessment should preferably be gender specific.
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