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Urinary tract infection in small children: the evolution of renal damage over time

Journal article
Authors Svante Swerkersson
Ulf Jodal
Rune Sixt
Eira Stokland
Sverker Hansson
Published in Pediatric Nephrology
Volume 32
Issue 10
Pages 1907-1913
ISSN 0931-041X
Publication year 2017
Published at Institute of Clinical Sciences, Department of Pediatrics
Pages 1907-1913
Language en
Links doi.org/10.1007/s00467-017-3705-5
Keywords Urinary tract infection, Children, Vesicoureteral reflux, Renal damage, primary vesicoureteral reflux, acute pyelonephritis, adult women, childhood, infants, lesions, Pediatrics, Urology & Nephrology
Subject categories Pediatrics, Urology and andrology

Abstract

Our objective was to analyze the evolution of kidney damage over time in small children with urinary tract infection (UTI) and factors associated with progression of renal damage. From a cohort of 1003 children < 2 years of age with first-time UTI, a retrospective analysis of 103 children was done. Children were selected because of renal damage at index Tc-99m-dimercaptosuccinic acid (DMSA) scintigraphy at least 3 months after UTI, and a late DMSA scan was performed after at least 2 years. Damage was classified as progression when there was a decline in differential renal function (DRF) by ae4%, as regression when there was complete or partial resolution of uptake defects. Of 103 children, 20 showed progression, 20 regression, and 63 remained unchanged. There were no differences between groups regarding gender or age. In the progression group, 16/20 (80%) children had vesicoureteral reflux (VUR) grade III-V and 13 (65%) had recurrent UTI. In multivariable regression analysis, both VUR grade III-V and recurrent UTI were associated with progression. In the regression group, 16/20 (80%) had no VUR or grade I-II, and two (10%) had recurrent UTI. Most small children with febrile UTI do not develop renal damage and if they do the majority remain unchanged or regress over time. However, up to one-fifth of children with renal damage diagnosed after UTI are at risk of renal deterioration. These children are characterized by the presence of VUR grades III-V and recurrent febrile UTI and may benefit from follow-up.

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