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Journal Club
Dec 2012

Long-term Follow-up of Patients After Childhood Urinary Tract Infection

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Author Affiliations

Author Affiliations: Departments of Pediatrics (Drs Hannula, Venhola, Renko, and Uhari and Ms Pokka) and Radiology (Dr Perhomaa), University of Oulu, Oulu, Finland.

Arch Pediatr Adolesc Med. 2012;166(12):1117-1122. doi:10.1001/archpediatrics.2012.1383

Objective To evaluate the long-term outcome of children with urinary tract infection (UTI).

Design Follow-up examination 6 to 17 years after childhood UTI.

Setting Secondary to tertiary referral center.

Patients From an original population-based cohort of 1185 children with a history of UTI on whom both ultrasonography (US) and voiding cystourethrography had been performed between January 1, 1993, and December 31, 2003, we excluded 24 cases with major renal dysplasia or obstruction of the urinary tract to form a study cohort of 1161 patients. We took a stratified random sample of 228 patients for follow-up, and a total of 193 (85%) participated. Of the 193 participating patients, 103 (53%) had received antibiotic prophylaxis and 42 (22%) had undergone surgery.

Main Exposure Urinary tract infection.

Main Outcome Measures Renal growth and parenchymal damage in US examination, kidney function, and blood pressure.

Results Unilateral renal parenchymal defect was found in 22 of the 150 patients (15%) studied with US at follow-up, and unilateral kidney growth retardation was found in 5 patients (3%). All but 1 of the renal parenchymal defects seen on US were in patients with grade III to V vesicoureteral reflux. Despite the parenchymal defects seen on US, the serum cystatin C concentration, estimated glomerular filtration rate, and blood pressure were within the normal ranges in all patients.

Conclusions The risk of long-term consequences from childhood UTI seems to be very low. Owing to the observational nature of our study, we cannot exclude the effects of the given treatment on the outcome of our patients.