Summary
Introduction
Febrile urinary tract infection (UTI) is a common childhood infection related to renal
scarring and potentially long-term complications like chronic kidney disease. It would
be of great benefit to find a correlation between easy-accessible factors in the acute
phase of a febrile UTI and the development of renal scar formation and/or decreased
renal function in order to identify children at risk of future complications.
Objective
The aim of this study was to identify factors associated with the development of decreased
split renal function (DSRF) and/or permanent renal scar formation in children with
febrile UTI.
Study design
The medical records of 212 Children aged 0 months to 15 years with febrile UTI admitted
to The Pediatric Department of Lillebaelt Hospital, Kolding from January 2011 to September
2014 were systematically reviewed. We analyzed clinical, laboratory, and radiologic
findings. Statistical analysis was performed to identify factors associated with renal
scar formation and DSRF on nuclear imaging at 6 months follow-up.
Results
A total of 113 medical records were eligible for further analysis, 99 girls and 14
boys, 34 patients younger than 12 months. In total 30 patients (26.5%) had an abnormal
follow-up imaging (DSRF less than 45% and/or renal scarring). Nine patients (8%) had
renal scarring. Four patients (3.5%) had renal scarring only, 21 patients (18.6%)
had DSRF only, and five patients (4.4%) had both renal scarring and DSRF. Patients
with renal scar formation on follow-up imaging had significantly higher C-reactive
protein (CRP) than patients with no scarring (p < 0.01). CRP and absolute neutrophil
count (ANC) was significantly higher in patients with abnormal follow-up imaging (p < 0.01
and p = 0.010), and these patients more often had positive nitrite in urine dipstick
compared to patients with normal kidneys on follow-up (p = 0.048). Temperature above
38.5 °C and CRP >50 mg/L in combination were also associated with a higher risk of
abnormal follow-up imaging (p = 0.016).
Discussion
This study contributes with further knowledge to the ongoing debate regarding renal
scarring but also reveals the possibility of associated factors for the development
of DSRF following a febrile UTI in children. However, due to the retrospective design
as well as the small number of events in our study definite conclusions on whether
the above-mentioned factors are indeed prognostic for the development of renal scarring
or DSRF following a febrile UTI can not be drawn.
Keywords
Abbreviations:
ANC (absolute neutrophil count), CRP (C-reactive protein), DMSA (dimercapto-succinyl acid), DSRF (decreased split renal function), US (ultrasonography), UTI (urinary tract infection), VUR (vesico-ureteral reflux), WBC (white blood cell count)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 17, 2022
Accepted:
September 13,
2022
Received in revised form:
August 24,
2022
Received:
January 12,
2022
Identification
Copyright
© 2022 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
