CLINICAL QUESTION

What are the long-term consequences of urinary tract infections (UTIs) in children?

BOTTOM LINE

In this population-based study, only 1.25% of children with UTIs in their first 5 years of life will have renal scarring by 7 years of age, and those children do not appear to be at increased risk of developing hypertension, chronic kidney disease (CKD), or end-stage renal failure. (Level of Evidence = 2b)

SYNOPSIS

Much of what is known about the consequences of UTIs in children comes from secondary care settings or from children with underlying pathology, such as vesicoureteral reflux. The authors used national databases to identify 159,201 children residing in Wales during their first 5 years of life who had full microbiologic test results. The researchers diagnosed UTIs based on urine culture and used diagnostic codes from medical records to determine if the children developed renal scarring, hypertension, CKD, or end-stage renal failure. In their analyses, the authors adjusted for sex, comorbidities, known congenital anomalies, and vesicoureteral reflux. More than one-fourth of the children (27.4%) had a urine culture analyzed, and 11,099 (7%) of those children had at least one positive culture result. The mean follow-up was 9.5 years and nearly 100% of the children had at least 5 years of follow-up data. Only 0.13% (208) of the 159,201 children had renal scarring by 5 years of age and 0.16% by 7 years of age. In children with at least one UTI, 0.99% (adjusted odds ratio [aOR] = 4.03; 95% CI, 2.81 to 5.79) had renal scarring by 5 years of age and 1.24% (aOR = 4.60; 95% CI, 3.33 to 6.35) by 7 years of age. After adjustment, the authors found no statistical association between UTI and hypertension, CKD, or end-stage renal failure in children up to 5 years of age or when all available data were used (up to an average age of 10 years). A total of 83% of the children with a UTI who had renal scarring by 5 years of age also had vesicoureteral reflux. Post-hoc analysis showed that children with only one UTI did not have higher odds of renal scarring than those without UTI (aOR = 1.34; 95% CI, 0.91 to 1.98); however, children with more than one UTI had higher odds (aOR = 7.09; 95% CI, 4.39 to 11.45).