Temporary Renal Enlargement in Children with a First Episode of Febrile Urinary Tract Infection is a Significant Risk of Recurrent Infection
Vol. 19 No. 04 (2022),
Purpose: Although morphological renal abnormalities in children with febrile urinary tract infection (fUTI) have been showed a predictive factor for recurrent infection, there are no available data on recurrence regarding sonographic renal enlargement at first fUTI episode, especially focusing on whether renal enlargement is temporary or not.
Materials and Methods: This cohort study reviewed the medical records of children who underwent renal ultrasound during their first fUTI during 2005–2013 and who were aged <15 years at diagnosis. We defined a kidney as temporary enlarged when the kidney length was ≥2 standard deviation above normal renal length for that age on sonography or a difference of ≥1 cm in sonographic length between the right and left kidneys, following normal renal length after antibiotic treatment.
Results: A total of 132 children were enrolled, of whom 11 had sonographic temporary temporal renal enlargement during their first fUTI. After completing antibiotic therapy for a first fUTI episode, 20 (15%) children had fUTI recurrence. The clinical characteristics at first episode of fUTI were not significantly different between renal enlargement and nonrenal enlargement groups. Children with temporary renal enlargement at a first fUTI episode had significantly lower fUTI recurrence-free survival proportion than those with nonrenal enlargement according to the Kaplan–Meier method (p = 0.003)
Conclusion: Identification of temporary temporal renal enlargement as a predictor of recurrent fUTI may help identify children with a first episode of fUTI who will be warned of close monitoring.
- children; febrile urinary tract infection; recurrence; renal sonography, temporary renal enlargement
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2. Conway PH, Cnaan A, Zaoutis T, Henry BV, Grundmeier RW, Keren R. Recurrent urinary tract infections in children: risk factors and association with prophylactic antimicrobials. JAMA 2007; 298: 179-86.
3. Hoberman A, Wald ER, Hickey RW, et al. Oral versus initial intravenous therapy for urinary tract infection in young febrile children. Pediatrics 1999; 104: 79-86.
4. Martinell J, Hansson S, Claesson I, Jocobsson B, Lidin-Janson G, Jodal U. Detection of urographic scars in girls with pyelonephritis followed for 13-38 years. Pediatr Nephrol 2000; 14: 1006-10.
5. Wennerstrom M, Hansson S, Jodal U, Stokland E. Primary and acquired renal scarring in boys and girls with urinary tract infection. J Pediatr 2000; 136: 30-4.
6. Panaretto KS, Craig JC, Knight JF, Howman-Giles R, Sureshkumar P, Roy LP. Risk factors for recurrent urinary tract infection in preschool children. J. Pediatr Child Health 1999; 35: 454-9.
7. Johansson B, Berg U, Svensson L. Renal damage after acute pyelonephritis. Arch Dis Child 1994; 70: 111-5.
8. Rushton Hg. The evaluation of acute pyelonephritis and renal damage with technetium99m-dimercaptosuccinic acid renal scintigraphy: Evolving concepts and future directions. Pediatr Nephrol 1997; 11: 108-20.
9. Subcommittee on urinary tract infection, steering committee on quality improvement and management, Roberts KB. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics 2011; 128: 595-610.
10. Avner ED, Harmon WE, Niaudet P, Yoshikawa N. Pediatric nephrology, 6th edn. Springer, Berlin Heidelberg, New York, 2009. 299-310.
11. Pickworth FE, Carlin JB, Ditchfield MR, et al. Sonographic measurement of renal enlargement in children with acute pyelonephritis and time needed for resolution: implications for renal growth assessment. AJR 1995; 165: 405-8.
12. Dinkel E, Orth S, Dittrich M, Schulte-Wisermann H. Renal sonography in the differentiation of upper from urinary tract infection. AJR 1986; 146: 755-80.
13. Peratoner L, Pennesi M, Bordugo A, et al. Kidney length and scarring in children with urinary tract infection: importance of ultrasound scans. Abdom Imaging 2005; 30: 780-5.
14. Bouissou F, Munzer C, Decramer S, et al. Prospective randomized trial comparing short and long intravenous antibiotic treatment of acute pyelonephritis in children: dimercaptosuccinic acid scintigraphic evaluation at 9 months. Pediatrics 2008; 121: e553-60.
15. Muller L, Preda I, Jocobsson B, et al. Ultrasonography as predictor of permanent renal damage in infants with urinary tract infection. Acta Pediatr 2009; 98: 1156-61.
16. Fernbach SK, Maizels M, Conway JJ. Ultrasound grading of hydronephrosis: introduction to the system used by the Society for Fetal Urology. Pediatr Radiol 1993; 23: 478-80.
17. Rosembaum DM, Korngold E, Teele RL. Sonographic assessment of renal length in normal children. AJR 1984; 142: 467-9.
18. Lebowitz RL, Olbing H, Parkkulainen KV, Smellie JM, Tamminen-Mobius TE. International Reflux Study in Children. International system of radiographic grading of vesicoureteric reflux. Pediatr Radiol 1985; 15: 105-9.
19. Shaikh N, Morone NE, Bost JE, Farrell MH. Prevalence of urinary tract infection in childhood: a meta-analysis. Pediatr Infect Dis J 2008; 27: 302-8.
20. Singh-Grewal D, Macdessi J, Craig J. Circumcision for the prevention of urinary tract infection in boys: a systematic review of randomized trial and observational studies. Arch Dis Child 2005; 90: 853-8.
21. Jodal U. The natural history of bacteriuria in childhood. Infect Dis Clin North Am 1987; 1: 713-29.
22. Carpenter MA, Hoberman A, Mattoo TK, et al. The RIVUR Trial: profile and baseline clinical associations of children with vesicoureteral reflux. Pediatrics 2013; 132: e34-45.
23. Hoberman A, Charron M, Hickey RW, Baskin M, Kearney DH, Wald ER. Imaging study after a first febrile urinary tract infection in young children. N Engl J Med 2003; 348: 195-202.
24. Simicic MA, Arapovic A, Saraga-Babic M, et al. Intrarenal Reflux in the Light of Contrast-Enhanced Voiding Urosonography. Front Pediatr 2021; Mar 2;9:642077. doi: 10.3389/fped.2021.642077. eCollection 2021.
25. Colleran GC, Barnewolt CE, Chow JS, Paltiel HJ. Intrarenal Reflux: Diagnosis and Contrast-Enhanced Voiding Urosonography. J Ultrasound Med 2016; 35: 1811-9.
26. Montini G, Zucchetta P, Tomasi L, et al. Value of imaging studies after a first febrile urinary tract infection in young children: data from Italian infection study 1. Pediatrics 2009; 123: e239-43.
27. Marks SD, Gordon I, Tullus K. Imaging in childhood urinary tract infections: time to reduce investigations. Pediatr Nephrol 2008; 23: 9-17.
28. Craig JC, Simpson JM, Williams GJ, et al. Antibiotic prophylaxis and recurrent urinary tract infection in children. N Engl J Med 2009; 361: 1748-59.
29. Johansson B, Troell S, Berg U. Renal parenchymal volume during and after acute pyelonephritis measured by ultrasonography. Arch Dis Child 1988; 63: 1309-14.
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