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Pediatric Nephrology
Published in: Pediatric Nephrology 10/2017

Open Access 01-10-2017 | Original Article

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

Authors: Svante Swerkersson, Ulf Jodal, Rune Sixt, Eira Stokland, Sverker Hansson

Published in: Pediatric Nephrology | Issue 10/2017

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Abstract

Background

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.

Methods

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 99mTc-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 ≥4%, as regression when there was complete or partial resolution of uptake defects.

Results

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.

Conclusions

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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Metadata
Title
Urinary tract infection in small children: the evolution of renal damage over time
Authors
Svante Swerkersson
Ulf Jodal
Rune Sixt
Eira Stokland
Sverker Hansson
Publication date
01-10-2017
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Nephrology / Issue 10/2017
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-017-3705-5

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