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Renal scars in children with febrile urinary tract infection - Looking for associated factors

  • Author Footnotes
    1 Present address: Department of Pediatrics, Regionshospitalet Viborg, Heibergs Alle 5A, 8800 Viborg, Denmark
    Tanja Hübertz Horsager
    Correspondence
    Correspondence to: T. H. Horsager, Department of Pediatrics, Regionshospitalet Viborg, Heibergs Alle 5A, 8800 Viborg, Denmark
    Footnotes
    1 Present address: Department of Pediatrics, Regionshospitalet Viborg, Heibergs Alle 5A, 8800 Viborg, Denmark
    Affiliations
    Department of Paediatrics and Adolescence Medicine, Lillebaelt Hospital Kolding, Kolding, Denmark
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  • Søren Hagstrøm
    Affiliations
    Department of Paediatrics, Aalborg University Hospital, Aalborg, Denmark
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  • Regitze Skals
    Affiliations
    Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
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  • Louise Winding
    Affiliations
    Department of Paediatrics and Adolescence Medicine, Lillebaelt Hospital Kolding, Kolding, Denmark
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  • Author Footnotes
    1 Present address: Department of Pediatrics, Regionshospitalet Viborg, Heibergs Alle 5A, 8800 Viborg, Denmark
Published:September 17, 2022DOI:https://doi.org/10.1016/j.jpurol.2022.09.012

      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)
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