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Compensatory kidney growth in children with urinary tract infection and unilateral renal scarring: an epidemiologic
Insights
Children with kidney scarring from urinary tract infections show good kidney function preservation. Prompt treatment and long-term supervision lead to excellent prognosis, with contralateral kidney hypertrophy compensating for damage.
Area of Science:
- Pediatric Nephrology
- Renal Physiology
- Urology
Background:
- Urinary tract infections (UTIs) in children can lead to unilateral renal scarring.
- The long-term impact of renal scarring on kidney growth and function requires further understanding.
Purpose of the Study:
- To estimate compensatory renal growth in children with unilateral renal scarring following UTI.
- To assess the impact of renal scarring on total renal parenchymal area and glomerular filtration rate (GFR) over time.
Main Methods:
- Longitudinal study of 26 children with unilateral renal scarring from a cohort of 596 UTI patients.
- Repeated urograms over 8-15 years to measure renal area, length, and parenchymal thickness.
- Analysis of factors influencing prognosis, including sex, age at onset, and complications like vesicoureteric reflux.
Main Results:
- Unilateral renal scarring was compensated by contralateral kidney hypertrophy, maintaining total renal parenchymal area at 98-99% of normal.
- Renal area measurements effectively tracked compensatory growth and substance loss.
- A pubertal growth spurt was observed in some scarred kidneys, even a decade post-injury.
- Prognosis was not significantly affected by sex, age at onset, or complications such as reflux or recurrent infections.
Conclusions:
- Children with acute febrile pyelonephritis have a good prognosis for renal parenchyma preservation and GFR if diagnosed and treated promptly.
- Long-term supervision is crucial for managing children with UTIs and renal scarring.
- Contralateral kidney hypertrophy effectively compensates for unilateral renal damage, preserving overall renal function.
Abstract:
Compensatory renal growth was estimated from repeated urograms over 8 to 15 years in 26 children with urinary tract infection and unilateral renal scarring. These children were derived from an unselected series of 596 patients followed from their first symptomatic urinary tract infection. Renal size was assessed from the renal area, length, and parenchymal thickness. The renal area proved to be a good measure of the compensatory growth of the unscarred kidney as well as of the loss of substance of the scarred kidney. In this series of children, who had been closely supervised from the time of their first infection, unilateral renal scarring was well compensated for by hypertrophy of the contralateral kidney. Thus, the total renal parenchymal area 8 to 15 years after the first investigation was 98 to 99% of the expected normal area. Interestingly, a conspicuous growth spurt was observed at puberty in some of the scarred kidneys, sometimes a decade after the original damage. Prognosis was not influenced by sex, age at onset, or complications such as vesicoureteric reflux and frequent febrile recurrences. Reflux with dilatation was compatible with compensatory renal growth. We conclude that acute febrile pyelonephritis in childhood carries a good prognosis with regard to preservation of renal parenchyma and level of GFR, if diagnosis and treatment are prompt and long-term supervision is provided.