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Published on: July 18, 2017
Association between hyponatremia and disease severity in pediatric urinary tract infections
Fu-Wen Liang1,2,3, Ying-Jia Lin4, Chung-Han Ho4,5
1Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan.
Insights
Hyponatremia in pediatric urinary tract infections (UTIs) may signal more severe illness, including acute pyelonephritis (APN), elevated CRP, and abnormal kidney ultrasounds. Further research is needed to understand these complex associations.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Clinical Chemistry
Background:
- Urinary tract infections (UTIs) are common in children, with potential for severe outcomes like acute pyelonephritis (APN).
- Identifying markers for disease severity in pediatric UTIs is crucial for timely and appropriate management.
- Inpatient pediatric UTI cases often present with more severe clinical symptoms.
Purpose of the Study:
- To investigate the association between hyponatremia and disease severity in pediatric patients with UTIs.
- To identify potential clinical and laboratory markers that predict severe outcomes in pediatric UTIs.
- To evaluate the correlation between serum sodium levels and the likelihood of APN.
Main Methods:
- Retrospective review of pediatric UTI/APN patients admitted between October 2012 and September 2022.
- Classification of patients into 'hyponatremia' and 'eunatremia' groups based on serum sodium levels.
- Analysis of clinical data, including renal ultrasound, blood tests (CRP, glucose), and urine tests, using multivariable logistic regression.
Main Results:
- The study included 344 pediatric UTI patients; 28.8% presented with hyponatremia.
- Patients with hyponatremia showed higher frequencies of APN, renal echo abnormalities, and elevated C-reactive protein (CRP) levels.
- Multivariable analysis indicated hyponatremia was independently associated with increased serum glucose and CRP levels.
Conclusions:
- Hyponatremia in pediatric UTI patients may serve as an indicator of more severe disease, including APN, elevated CRP, and renal abnormalities.
- The findings suggest a potential role for serum sodium levels as a severity marker in pediatric UTIs.
- Further investigation is warranted to elucidate the underlying mechanisms of hyponatremia in this population and confirm its predictive value for disease severity.
Background:
Acute urinary tract infection (UTI) is a common disease in pediatrics, with around 8% of girls and 2% of boys experiencing a UTI by age 7y/o. UTIs can range from asymptomatic bacteriuria to acute pyelonephritis (APN) in severe cases involving renal parenchymal infection. UTI patients admitted to the pediatric ward usually have more severe clinical presentation, compared to those treated in the outpatient settings. Therefore, it will be helpful to have markers that predict the severity of the disease and the likelihood of having APN.
Methods:
We performed a retrospective review on all pediatric UTI/APN patients treated in the inpatient setting at a Medical Center from October 2012 to September 2022. Patients were assigned to the "hyponatremia" or "eunatremia" group according to their serum sodium concentrations. Detailed information, including renal echo, blood, and urine test results, were collected for the analysis of multivariable logistic regression model.
Results:
The study included 344 patients, of which 99 (28.8%) had hyponatremia, and 245 (71.2%) had normal serum sodium levels. The hyponatremia group had higher APN frequency, renal echo abnormality, and higher CRP level. In multivariable analysis, hyponatremia was independently associated with increased serum glucose (OR: 1.01, 95% CI: 1.00-1.03, p = 0.0365) and CRP levels (OR: 1.00, 95% CI: 1.00-1.01, p = 0.0417), without a significant increase in APN frequency as the final diagnosis.
Conclusions:
Our findings suggest that hyponatremia in pediatric UTI patients may indicate a more severe disease, such as APNs, higher CRP levels, or renal echo abnormalities. The complex mechanisms underlying hyponatremia and its predictive value for disease severity warrant further investigation.
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