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Urinary tract infection in small children: the evolution of renal damage over time

Svante Swerkersson1, Ulf Jodal2, Rune Sixt3

  • 1Department of Pediatric Uronephrologic Center, Sahlgrenska Academy, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, 416 85, Göteborg, Sweden. svante.swerkersson@gu.se.

Pediatric Nephrology (Berlin, Germany)
|July 7, 2017
PubMed

Insights

Most children with urinary tract infection (UTI) do not develop kidney damage. However, severe reflux and recurrent UTIs increase the risk of renal damage progression in young children.

Area of Science:

  • Pediatric Nephrology
  • Pediatric Urology
  • Infectious Diseases

Background:

  • Urinary tract infections (UTIs) are common in infants and young children.
  • Assessing the long-term renal outcomes after UTI is crucial for pediatric patient management.
  • Kidney damage following UTI can have significant implications for renal health.

Purpose of the Study:

  • To analyze the evolution of kidney damage over time in children under two years old following a first-time UTI.
  • To identify factors associated with the progression or regression of renal damage after UTI.

Main Methods:

  • Retrospective analysis of 103 children under two years with first-time UTI and initial renal damage.
  • Renal damage assessed by technetium-99m dimercaptosuccinic acid (DMSA) scintigraphy at least 3 months post-UTI and again after 2 years.
  • Progression defined as a decline in differential renal function (DRF) ≥4%; regression defined as resolution of uptake defects.

Main Results:

  • Of 103 children, 20 showed progression, 20 regression, and 63 remained unchanged.
  • Progression was significantly associated with high-grade vesicoureteral reflux (VUR) (grade III-V) and recurrent UTIs.
  • Regression was associated with no VUR or low-grade VUR (grade I-II) and infrequent recurrent UTIs.

Conclusions:

  • The majority of young children with UTI do not experience worsening kidney damage; damage often remains stable or improves.
  • A significant minority (up to 20%) of children with initial renal damage are at risk of deterioration.
  • Children with high-grade VUR and recurrent UTIs require closer monitoring for potential renal damage progression.
Abstract

Keywords:
ChildrenRenal damageUrinary tract infectionVesicoureteral reflux

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