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Published on: June 24, 2025
Delayed Therapeutic Response Time Predicts Renal Damage in the First Episode of Febrile Urinary Tract Infection
Insights
Therapeutic response time (TRT) over 22 hours predicts kidney damage in children after their first febrile urinary tract infection (UTI). Prompt treatment is crucial to prevent renal scarring.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Diagnostic Imaging
Background:
- Febrile urinary tract infections (UTIs) in children can lead to renal damage.
- Early detection and intervention are critical to prevent long-term sequelae.
- Dimercaptosuccinic acid (DMSA) renal scintigraphy is a key diagnostic tool for assessing renal scarring.
Purpose of the Study:
- To investigate the correlation between therapeutic delay time (TDT) and therapeutic response time (TRT) with renal damage in children experiencing their first episode of febrile UTI.
- To identify predictive markers for renal damage following a first UTI episode.
Main Methods:
- A prospective study involving 67 children with their first UTI episode.
- DMSA renal scintigraphy performed at one and six months post-infection to assess renal damage.
- Analysis of TDT and TRT in relation to DMSA findings.
Main Results:
- Abnormal DMSA findings were observed in 29.9% of patients.
- Therapeutic response time (TRT), but not TDT, was significantly different between patients with normal and abnormal DMSA scans (p=0.001).
- An optimal TRT cut-off of 22 hours predicted renal damage (AUC=0.76). In patients without vesicoureteral reflux (VUR), a TRT cut-off of 25 hours was predictive (AUC=0.82).
Conclusions:
- Therapeutic response time (TRT) of 22 hours or more is a significant predictor of renal damage after the first UTI episode.
- In children without VUR, a TRT of 25 hours or more indicates a higher risk of renal damage.
- Consideration of DMSA renal scintigraphy is recommended for children with a first UTI episode, especially those with prolonged TRT.
Objective:
To evaluate the relationship of therapeutic delay time (TDT) and therapeutic response time (TRT) with renal damage in the first episode of febrile urinary tract infection (UTI).
Material And Method:
A prospective study was conducted in 67 children with the first episode of UTI at the Department of Pediatrics, Faculty of Medicine Siriraj Hospital between 2008 and 2010. To assess for renal damage, dimercaptosuccinic acid (DMSA) renal scintigraphy was performed at one and six months after the acute episode.
Results:
Abnormal DMSA renal scintigraphy was detected in 20 (29.9%) patients. There was no difference in TDT but TRT was different between the patients with normal and abnormal DMSA renal scintigraphy at p-value 0.001. The area under receiver operating characteristic (ROC) curve for TRT was 0.76 (95% confidence interval (CI) 0.64-0.86) at p-value 0.001. The optimal cut-off value for TRT was 22 hours with sensitivity 80.0% (56.3-94.1) and specificity 63.6% (47.8-77.6). In 50 patients with no vesicoureteral reflux (VUR), there was difference in TRT at p-value 0.002. The area under ROC curve for TRT was 0.82 (95% CI 0.69-0.96) at p-value 0.004. The optimal cut-off value for TRT was 25 hours with sensitivity 88.9% (95% CI 51.7-98.2) and specificity 68.4% (95% CI 51.3- 82.5).
Conclusion:
TRT at or more than 22 hours predicts renal damage after first episode of UTI. In patients with no VUR, TRT at or more than 25 hours predicts renal damage. DMSA renal scintigraphy in the first episode of UTI should be considered in these patients.
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