Risk factors for kidney scarring and vesicoureteral reflux in 421 children after their first acute pyelonephritis, and appraisal of international guidelines

Breinbjerg, Anders; Jørgensen, Cecilie Siggaard; Frøkiær, Jørgen; Tullus, Kjell; Kamperis, Konstantinos; Rittig, Søren

doi:10.1007/s00467-021-05042-7

Cited by 17 publications

(16 citation statements)

References 37 publications

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“…In this study, non‐ E. coli infection was the most closely associated factor with clinically significant urological anomalies. Many studies report that non‐ E. coli infection is one of the risk factors for renal malformations and scarring, 17,19,22–24 and one bacterial attachment study supports it 25 . The 2007 NICE guideline and the 2019 Italian guidelines demonstrate that VCUG should be performed for non‐ E. coli infections 5,8 .…”

Section: Discussionmentioning

confidence: 99%

“…renal scarring. 8,24 However, none of them give a specific value for Scr level. Elevated Scr level in the group with clinically significant urological anomalies may be acute change due to susceptibility to UTI or may indicate that very mild renal dysfunction begins from earliest childhood.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, it was significantly elevated in the group with clinically significant urological anomalies (Table 1). The 2007 NICE guideline shows that raised creatinine level is one of the VCUG applications: one study shows that elevated creatinine according to age is one of the predictors of renal scarring 8,24 . However, none of them give a specific value for Scr level.…”

Section: Discussionmentioning

confidence: 99%

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Predicting factors of clinically significant urological anomalies after initial urinary tract infection among 2‐ to 24‐month‐old children

Banno

Sugiyama

2022

Acta Paediatrica

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Aim: To find more effective criteria to identify clinically significant urological anomalies after initial urinary tract infection among children. Methods:Children aged 2-24 months with an initial urinary tract infection were consecutively recruited in a Japanese hospital from 2013 to 2019. Voiding cystourethrography, 99mTc dimercaptosuccinic acid scan and ultrasound were intended to perform for all cases. Clinically significant urological anomalies were defined as high-grade vesicoureteral reflux, obstructive and abnormal urinary tract lesions, need for surgical intervention, renal hypoplasia and scarring. Using classification and regression tree analysis, we sought the associated factors. We developed new criteria with these factors, retrospectively applied them to the original data, and calculated the sensitivity and specificity.Results: One hundred sixty-seven patients were eligible, and 39 had clinically significant urological anomalies. Classification and regression tree analysis showed that the associated factors were non-E. coli infections, serum creatinine levels and ultrasound abnormalities. When the gold standards were performed on children with non-E. coli infections or serum creatinine levels ≥0.21 mg/dl, sensitivity and specificity were 0.82 and 0.68, respectively. Conclusion:The criteria including non-E. coli infections and high-normal or higher serum creatinine levels may efficiently predict clinically significant urological anomalies after initial urinary tract infections.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Predicting factors of clinically significant urological anomalies after initial urinary tract infection among 2‐ to 24‐month‐old children

Banno

Sugiyama

2022

Acta Paediatrica

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“…This discrepancy may be due to the unbalanced alterations in muscle mass and tubular secretion and their effects on the SCr levels [ 38 ]. Breinbjerg et al [ 39 ] also found that even non- E. coli infections can lead to an elevated SCr in children after their first ANP. In addition, Megged [ 40 ] found that SCr was the only independent risk factor for bacteremia among children with UTI.…”

Section: Discussionmentioning

confidence: 99%

Demographic, clinical, and laboratory factors associated with renal parenchymal injury in Iranian children with acute pyelonephritis

et al. 2021

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Background The association between renal parenchyma changes on dimercaptosuccinic acid (DMSA) scans and demographic, clinical, and laboratory markers was assessed in pediatric patients with acute pyelonephritis. Methods A retrospective study of 67 Iranian babies and children aged 1-month to 12-year with APN was conducted between 2012 and 2018. The presence of renal parenchymal involvement (RPI) during APN was determined using technetium-99m DMSA during the first 2 weeks of hospitalization. The association of DMSA results with demographic data, clinical features (hospitalization stay, fever temperature and duration), and laboratory parameters such as pathogen type, and hematological factors (ESR, CRP, BUN, Cr, Hb, and WBC) was evaluated. Results 92.5% of children with an average age of 43.76 ± 5.2 months were girls. Twenty-four children (35.8%) did not have renal parenchymal injury (RPI), while 26 (38.8%) and 17 (25.4%) patients showed RPI in one and both kidneys, respectively. There was no significant association between RPI and mean ESR, CRP, BUN, and WBC. However, there were significant associations between RPI and higher mean levels of Cr, Hb, and BMI. Conclusions Low BMI and Hb levels and increased Cr levels might be indicative of the presence of RPI in children with APN.

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“… 1 , 2 Pyelonephritis is defined as an upper UTI involving the upper urinary tract and kidney parenchyma. This potentially serious condition can lead to renal scarring, 3 , 4 which can further result in loss of kidney function and long‐term sequelae such as hypertension. 5 Approximately 85–95% of upper and lower UTIs are caused by Escherichia coli (E. coli).…”

Section: Introductionmentioning

confidence: 99%

Functional constipation as a risk factor for pyelonephritis and recurrent urinary tract infection in children

et al. 2022

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Urinary tract infection (UTI) is among the most common bacterial infections in childhood affecting up to 8.4% of girls and 1.7% of boys within the first 6 years of life. 1,2 Pyelonephritis is defined as an upper UTI involving the upper urinary tract and kidney parenchyma. This potentially serious condition can lead to renal scarring, 3,4 which can further result in loss of kidney function and long-term sequelae such as hypertension. 5 Approximately 85-95% of upper and lower UTIs are caused by Escherichia coli (E. coli). Klebsiella, Proteus, Enterococcus and Enterobacter species are other common organisms. 6 Kidney or urinary tract (UT) abnormalities, for example vesicoureteral reflux, (VUR) are well-established risk factors associated with UTI. 3,7 However, our knowledge on risk factors associated with UTI in children without kidney or UT abnormalities is limited. Few

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Risk factors for kidney scarring and vesicoureteral reflux in 421 children after their first acute pyelonephritis, and appraisal of international guidelines

Cited by 17 publications

References 37 publications

Predicting factors of clinically significant urological anomalies after initial urinary tract infection among 2‐ to 24‐month‐old children

Predicting factors of clinically significant urological anomalies after initial urinary tract infection among 2‐ to 24‐month‐old children

Demographic, clinical, and laboratory factors associated with renal parenchymal injury in Iranian children with acute pyelonephritis

Functional constipation as a risk factor for pyelonephritis and recurrent urinary tract infection in children

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