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

Artikel i vetenskaplig tidskrift
Författare Svante Swerkersson
Ulf Jodal
Rune Sixt
Eira Stokland
Sverker Hansson
Publicerad i Pediatric Nephrology
Volym 32
Nummer/häfte 10
Sidor 1907-1913
ISSN 0931-041X
Publiceringsår 2017
Publicerad vid Institutionen för kliniska vetenskaper, Avdelningen för pediatrik
Sidor 1907-1913
Språk en
Länkar doi.org/10.1007/s00467-017-3705-5
Ämnesord Urinary tract infection, Children, Vesicoureteral reflux, Renal damage, primary vesicoureteral reflux, acute pyelonephritis, adult women, childhood, infants, lesions, Pediatrics, Urology & Nephrology
Ämneskategorier Pediatrik, Urologi och andrologi

Sammanfattning

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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