Urinary tract infection: one lingering effect of childhood kidney diseases--review of the literature

Abstract

Urinary tract infection (UTI) is a possible warning sign of the presence of anomalies of the urinary tract. Following a UTI there is concern with recurrences which can contribute to scarring which may lead to hypertension, pregnancy-induced hypertension and even renal failure in later years. Prospective studies using 99mTc-labeled dimercaptosuccinic acid (DMSA) have shown that 30%-40% of children will have renal scarring after febrile UTI, regardless of the presence or absence of vesicoureteral reflux (VUR). Many studies have demonstrated that VUR is an important risk factor for renal scarring after UTI. Hypertension affects at least 10% of children with renal scarring, and in adults with reflux nephropathy (RN), the prevalence of hypertension is also much higher (38%-50%). UTI, pregnancy-induced hypertension (PIH) or renal function deterioration alone or in some combination has been reported to be as high as 39% in women with renal scarring. RN is one of the important causes of end-stage renal disease (ESRD) worldwide. Prevention of renal scar development should reduce the incidence of hypertension in patients as they age. The appropriate management of childhood UTI includes education of parents, patients and general physicians to be sure that everyone is aware of not only the current condition, but also the possibility of future UTI-related situations.

In conclusion: UTI itself is a warning sign of possible anomalies of the urinary tract, renal problems and/or chronic renal complications. Although VUR is primarily a disease of childhood, scarring from the disease can cause problems in later years, with the complicating factor that because only the renal scar remains, the VUR may be forgotten and not considered when diagnosing the current problem.