Predictors of renal scars in infants with recurrent febrile urinary tract infection: a retrospective, single-center study
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: To determine predictive factors for detecting renal parenchymal damages (RPDs) in infants with recurrent febrile urinary tract infection (fUTI).Methods: From January 2015 to December 2021, 102 infants with recurrent fUTI and who underwent 99mTc-dimercaptosuccinic acid (DMSA) renal scan in our hospital were included in this study. Controls included infants with normal DMSA results performed 3 months apart from the 2nd episode of fUTI. DMSA-positive group included infants with positive DMSA results performed 3 months apart from the 2nd episode of fUTI or at the 3rd episode of fUTI. The recurrence rate, causative bacteria, renal size discrepancy of both kidneys, and laboratory findings including C-reactive protein (CRP) and spot urine sodium-to-potassium ratio (uNa/K) were compared between both groups.Results: Only 3.8% of 79 infants with a 2nd episode of fUTI showed positive DMSA results. fUTI recurred more frequently within 12 months of follow-up in the DMSA-positive group than in the control group (69% vs. 13%, P=0.00). CRP values were significantly higher in the DMSA-positive group than in the control group (7.3 mg/dL vs. 3.7 mg/dL, P=0.00). Spot uNa/K were significantly lower in the DMSA-positive group than in the control group (0.6 vs. 1.1, P=0.00). Conclusions: Congenital renal scar and RPDs on the DMSA scan were more frequently found in infants with recurrent fUTI than those in the control group. High CRP values and low spot uNa/K in acute infections were helpful in predicting the presence of RPD in infants with recurrent fUTI.
Abstract
Purpose: To determine predictive factors for detecting renal parenchymal damages (RPDs) in infants with recurrent febrile urinary tract infection (fUTI).Methods: From January 2015 to December 2021, 102 infants with recurrent fUTI and who underwent 99mTc-dimercaptosuccinic acid (DMSA) renal scan in our hospital were included in this study. Controls included infants with normal DMSA results performed 3 months apart from the 2nd episode of fUTI. DMSA-positive group included infants with positive DMSA results performed 3 months apart from the 2nd episode of fUTI or at the 3rd episode of fUTI. The recurrence rate, causative bacteria, renal size discrepancy of both kidneys, and laboratory findings including C-reactive protein (CRP) and spot urine sodium-to-potassium ratio (uNa/K) were compared between both groups.Results: Only 3.8% of 79 infants with a 2nd episode of fUTI showed positive DMSA results. fUTI recurred more frequently within 12 months of follow-up in the DMSA-positive group than in the control group (69% vs. 13%, P=0.00). CRP values were significantly higher in the DMSA-positive group than in the control group (7.3 mg/dL vs. 3.7 mg/dL, P=0.00). Spot uNa/K were significantly lower in the DMSA-positive group than in the control group (0.6 vs. 1.1, P=0.00). Conclusions: Congenital renal scar and RPDs on the DMSA scan were more frequently found in infants with recurrent fUTI than those in the control group. High CRP values and low spot uNa/K in acute infections were helpful in predicting the presence of RPD in infants with recurrent fUTI.
참고문헌 (23)
- Chang SL, "Pediatric urinary tract infections", Pediatr Clin North Am, 53, pp.379~400 (2006)
- Scott Wang HH, "Topdown versus bottom-up approach in children presenting with urinary tract infection : comparative effectiveness analysis using RIVUR and CUTIE data", J Urol, 206, pp.1284~1290 (2021)
- O’Reilly SE, "A risk index for pediatric patients undergoing diagnostic imaging with(99m)Tc-dimercaptosuccinic acid that accounts for body habitus", Phys Med Biol, 61, pp.2319~2332 (2016)
- Subcommittee on Urinary Tract Infection, "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, 128, pp.595~610 (2011)
- Cain JE, "Genetics of renal hypoplasia : insights into the mechanisms controlling nephron endowment", Pediatr Res, 68, pp.91~98 (2010)
- Bonsib SM, "Renal hypoplasia, from grossly insufficient to not quite enough: consideration for expanded concepts based upon the author’s perspective with historical review", Adv Anat Pathol, 27, pp.311~330 (2020)
- Ahmed Abdelhalim, "Critical appraisal of the top-down approach for vesicoureteral reflux", Investigative and Clinical Urology, 58, pp.14~22 (2017), 대한비뇨의학회[DOI]
- Al Qahtani W, "Primary bilateral high-grade vesicoureteral reflux in children : management perspective", Cureus, 12, pp.e12266~ (2020)
- Jun Ho Lee, "Reconsideration of urine culture for the diagnosis of acute pyelonephritis in children: a new challenging method for diagnosing acute pyelonephritis", Clinical and Experimental Pediatrics, 62(12), pp.433~437 (2019), 대한소아청소년과학회
- Young Seo Park, "Renal scar formation after urinary tract infection in children", Clinical and Experimental Pediatrics, 55(10), pp.367~370 (2012), 대한소아청소년과학회
- Leroy S, "Association of procalcitonin with acute pyelonephritis and renal scars in pediatric UTI", Pediatrics, 131, pp.870~879 (2013)
- Soylu A, "Predictors of renal scar in children with urinary infection and vesicoureteral reflux", Pediatr Nephrol, 23, pp.2227~2232 (2008)
- Becerir T, "Urinary excretion of pentraxin-3 correlates with the presence of renal scar following acute pyelonephritis in children", Int Urol Nephrol, 51, pp.571~577 (2019)
- Jee Hyun Lee, "Associations of Plasma Neutrophil Gelatinase-associated Lipocalin, Anemia, and Renal Scarring in Children with Febrile Urinary Tract Infections", Journal of Korean Medical Science, 35(10), pp.1~14 (2020), 대한의학회[DOI]
- Gokce I, "Urinary levels of interleukin-6 and interleukin-8 in patients with vesicoureteral reflux and renal parenchymal scar", Pediatr Nephrol, 25, pp.905~912 (2010)
- 이준호, "Prediction of Cortical Defect Using C-Reactive Protein and Urine Sodium to Potassium Ratio in Infants with Febrile Urinary Tract Infection", Yonsei Medical Journal, 57(1), pp.103~110 (2016), 연세대학교의과대학[DOI]
- Lee JH, "Discrimination of culture negative pyelonephritis in children with suspected febrile urinary tract infection and negative urine culture results", J Microbiol Immunol Infect, 52, pp.598~603 (2019)
- Lee JH, "Antinatriuretic phenomena seen in children with acute pyelonephritis may be related to the activation of intrarenal RAAS", Medicine(Baltimore), 97, pp.e12152~ (2018)
- Kosmeri C, "An update on renal scarring after urinary tract infection in children: what are the risk factors?", J Pediatr Urol, 15, pp.598~603 (2019)
- Shaikh N, "Identification of children and adolescents at risk for renal scarring after a first urinary tract infection : a meta-analysis with individual patient data", JAMA Pediatr, 168, pp.893~900 (2014)
- Rodriguez LM, "Do serum C-reactive protein and interleukin-6 predict kidney scarring after urinary tract infection?", Indian J Pediatr, 80, pp.1002~1006 (2013)
- Bressan S, "Procalcitonin as a predictor of renal scarring in infants and young children", Pediatr Nephrol, 24, pp.1199~1204 (2009)
- Warady BA, "Chronic kidney disease in children : the global perspective", Pediatr Nephrol, 22, pp.1999~2009 (2007)