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[Symptomatic urinary infection in infants less than 4 months old: outcome in 129 cases]
Insights
Urinary tract infections in infants can lead to kidney damage. Early treatment of vesicoureteral reflux (VUR) and obstructive uropathy in children significantly reduces the risk of developing pyelonephritic scars and permanent kidney function alterations.
Area of Science:
- Pediatric Nephrology
- Urology
- Infectious Diseases
Context:
- Urinary tract infections (UTIs) in early infancy pose a significant risk for renal sequelae.
- Long-term outcomes for children with UTIs depend on the underlying pathology, such as vesicoureteral reflux (VUR) and obstructive uropathy.
Purpose:
- To evaluate the long-term renal outcomes in children treated for urinary infections during the first 120 days of life.
- To assess the impact of VUR grade and obstructive uropathy on the development of pyelonephritic scars and renal function.
Summary:
- A cohort of 129 infants with UTIs was followed for 1-16 years, categorized by VUR grade or obstructive uropathy.
- Surgical intervention was employed for obstructive uropathy and high-grade VUR (grade IV), while chemoprophylaxis was used for others.
- Complete resolution of low-grade VUR was observed, with significant resolution rates for moderate grades. Pyelonephritic scars were more prevalent in higher VUR grades and obstructive uropathy.
- Permanent renal function impairment was primarily associated with high-grade VUR and obstructive anomalies, irrespective of infection recurrence frequency.
Impact:
- This study highlights the importance of timely diagnosis and appropriate management of UTIs in infancy to prevent irreversible kidney damage.
- Findings underscore the correlation between the severity of VUR and obstructive uropathy and the risk of renal scarring and functional decline.
- Informs clinical decision-making regarding treatment strategies for pediatric UTIs to optimize long-term renal health outcomes.
Abstract:
A series of 129 children with urinary infection during the first 120 days of life, were followed-up for periods ranging from to 1 to 16 years (means = 4 1/12 year). They have been separated in two groups, depending on urocystographic findings: (I) with mild lesions and/or reflux (99 cases) and (II) with obstructive uropathy (30 cases). All the patients in group II and those with reflux of grade IV received surgical treatment. The remaining ones received chemoprophylaxis. During the follow-up, all grade I refluxes disappeared, and so did 86% of grade II and 58% of grade III. Pyelonephritic scars are present in 34% of those kidneys with grade III reflux, 56% of grade IV and 88% of those of the group II. Permanent alteration of renal function was found almost exclusively in patients with grade IV reflux or obstructive anomalies bearing no relation with the number of recurrences of infection during the follow-up.