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Acute pyelonephritis in children and the risk of end-stage kidney disease
Oren Pleniceanu1,2, Gilad Twig1,3,2,4, Dorit Tzur1
1Israel Defense Forces, Medical Corps, Ramat Gan, Israel.
Insights
A history of pyelonephritis significantly increases the risk of end-stage kidney disease (ESKD) in young adults. This risk is especially high when pyelonephritis is associated with kidney scarring or reduced kidney function.
Area of Science:
- Nephrology
- Pediatric Infectious Diseases
- Epidemiology
Background:
- Pyelonephritis is a common serious bacterial infection in childhood.
- The long-term consequences of kidney scarring from pyelonephritis remain unclear.
Purpose of the Study:
- To assess the long-term risk of end-stage kidney disease (ESKD) in adolescents and young adults with a history of pyelonephritis.
- To determine the impact of kidney scarring and baseline kidney function on ESKD risk.
Main Methods:
- A nationwide, population-based historical cohort study of 1,509,902 individuals examined for military service (1967-1997).
- Participants were sub-grouped based on pyelonephritis history, kidney scarring, and baseline kidney function.
- Data linkage with the Israeli ESKD registry and Cox proportional hazards models were used to estimate ESKD risk.
Main Results:
- Pyelonephritis was diagnosed in 0.46% of participants.
- Individuals with pyelonephritis and normal kidney function had a 3.3-fold increased risk of treated ESKD.
- This risk escalated to 34.8-fold with kidney scarring and 43.2-fold with reduced baseline kidney function.
Conclusions:
- A history of pyelonephritis is associated with a substantially increased risk of treated end-stage kidney disease.
- Kidney scarring and reduced baseline kidney function significantly amplify the risk of ESKD following pyelonephritis.
Background:
Pyelonephritis is the most common serious bacterial infection during childhood. The long-term importance of kidney scarring is unclear.
Objective:
To assess the risk of end-stage kidney disease (ESKD) in adolescents and young adults with history of pyelonephritis.
Study Design:
A nationwide, population-based, historical cohort study, including 1,509,902 persons (62% male) examined for military service between 1967 and 1997. Participants with a history of pyelonephritis were sub-grouped according to presence of kidney scarring and baseline kidney function. Data were linked to the Israeli ESKD registry to identify incident ESKD cases. Cox proportional hazards models were used to estimate the hazard ratio (HR) of treated ESKD (dialysis or kidney transplant).
Results:
Pyelonephritis was diagnosed in 6979 participants (0.46%). 6479 had normal kidney function and no evidence of kidney scarring, 400 had normal kidney function with evidence of scarring, and 100 demonstrated reduced baseline kidney function. Treated ESKD developed in 2352 individuals (0.2%) without history of pyelonephritis, 58 individuals (0.9%) with normal kidney function, history of pyelonephritis and no kidney scarring, 14 individuals (3.5%) with normal kidney function, history of pyelonephritis and kidney scarring, and 23 individuals (23.0%) with history of pyelonephritis and reduced baseline kidney function, yielding HR of 3.3, 34.8 and 43.2, respectively, controlling for age, gender, paternal origin, enrollment year, body mass index, and blood pressure, and accounting for death as a competing risk.
Conclusion:
History of pyelonephritis was associated with significantly increased risk of treated ESKD, particularly when associated with kidney scarring or reduced baseline kidney function.
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