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Clinical Characteristics of Febrile UTI First Developed Over 5 Years of Age

  • Roh, Da Eun (Department of Pediatrics, Kyungpook National University, School of Medicine) ;
  • Suh, Hyo Rim (Department of Pediatrics, Kyungpook National University, School of Medicine) ;
  • Min, So Yoon (Department of Pediatrics, Kyungpook National University, School of Medicine) ;
  • Jo, Tae Kyoung (Department of Pediatrics, Kyungpook National University, School of Medicine) ;
  • Baek, Hee Sun (Department of Pediatrics, Kyungpook National University, School of Medicine) ;
  • Cho, Min Hyun (Department of Pediatrics, Kyungpook National University, School of Medicine)
  • Received : 2017.02.13
  • Accepted : 2017.04.04
  • Published : 2017.04.30

Abstract

Purpose: Febrile urinary tract infection (UTI) is one of the commonest bacterial infections in children. The purpose of this study is to investigate the clinical characteristics of the first episode of febrile UTI occurring in children over 5 years compared to those in infants younger than a year. Methods: We retrospectively reviewed the medical records of 10 patients over 5 years, having febrile UTI, and 25 controls under 1 year. Clinical characteristics including symptoms at admission, the time interval between symptom onset and hospital visit and/or diagnosis, duration of fever, urinalysis, and other laboratory and imaging test results were compared between the two groups. Results: Most patients in the control group showed only high fever at the time of presentation to the hospital. However, 60% of the case group had fever along with gastrointestinal (GI) symptoms such as abdominal and flank pain, vomiting, as well as relatively mild pyuria. The case group showed a longer duration between symptom onset and hospital visit and/or diagnosis. Conclusions: Delay in diagnosis and initiation of treatment of UTI increases the risk of permanent renal scarring and associated complications. Therefore, early diagnosis and treatment of febrile UTI is vital for very young infants, as well as children considering that febrile UTI could be an important cause of febrile illness in children over 5 years.

Keywords

References

  1. Lee KY. New insights for febrile urinary tract infection (acute pyelonephritis) inchildren. ChildKidney Dis 2016;20:37-44.
  2. Kim JH, Kim MJ, Choi BM, Yoo KH, Hong YS, Lee JW. The diagnostic value of clinical and radiologic findings in children after the first episode of acute pyelonephritis. J Korean Soc Pediatr Nephrol 2005;9:201-12.
  3. Coe HJ, Kim TH, Cho H, Kim JH. Comparison of the clinical and radiologic characteristics between different age groups with first febrile UTI under 2 years of age. J Korean Soc Pediatr Nephrol 2007;11:229-38. https://doi.org/10.3339/jkspn.2007.11.2.229
  4. 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. https://doi.org/10.1097/INF.0b013e31815e4122
  5. Matthews KE, Mines RD, Pakula LC. Practice parameter: the diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. Pediatrics 1999;103:843. https://doi.org/10.1542/peds.103.4.843
  6. Doganis D, Siafas K, Mavrikou M, Issaris G, Martirosova A, Perperidis G. Does early treatment of urinary tract infection prevent renal damage? Pediatrics 2007;120:e922-8. https://doi.org/10.1542/peds.2006-2417
  7. Shaw KN, Gorelick M, McGowan KL, Yakscoe NM, Schwartz JS. Prevalence of urinary tract infection in febrile young children in the emergency department. Pediatrics 1998;102:e16. https://doi.org/10.1542/peds.102.2.e16
  8. Hoberman A, Chao HP, Keller DM, Hickey R, Davis HW, Ellis D. Prevalence of urinary tract infection in febrile infants. J Pediatr 1993;123:17-23. https://doi.org/10.1016/S0022-3476(05)81531-8
  9. Lee SJ. Guidelines for childhood urinary tract infection. Korean J Pediatr 2009;52:976-83. https://doi.org/10.3345/kjp.2009.52.9.976
  10. Shaikh N, Morone NE, Lopez J, Chianese J, Sangvai S, D'Amico F. Does this child have a urinary tract infection? JAMA 2007;298: 2895-904. https://doi.org/10.1001/jama.298.24.2895
  11. Oh MM, Cheon J, Kang SH, Park HS, Lee JG, Moon DG. Predictive factors for acute renal cortical scintigraphic lesion and ultimate scar formation in children with first febrile urinary tract infection. J Urol 2010;183:1146-50. https://doi.org/10.1016/j.juro.2009.11.051
  12. Lee YJ, Lee JH, Park YS. Risk factors for renal scar formation in infants with first episode of acute pyelonephritis: a prospective clinical study. J Urol 2012;187:1032-6. https://doi.org/10.1016/j.juro.2011.10.164
  13. Benador D, Benador N, Slosman D, Mermilllod B, Girardin E. Are younger children at highest risk of renal sequelae after pyelonephritis? The Lancet 1997;349:17-9. https://doi.org/10.1016/S0140-6736(96)06126-0
  14. An YK, Cho MH, Kim KS. Which factors related to the renal cortical defects in infants under 3 months of age with urinary tract infections? Child Kidney Dis2016;20:57-62. https://doi.org/10.3339/jkspn.2016.20.2.57
  15. Park YS. Renal scar formation after urinary tract infection in children. Korean JPediatr 2012;55:367-70. https://doi.org/10.3345/kjp.2012.55.10.367
  16. Montini G, Tullus K, Hewitt I. Febrile urinary tract infections in children. N Engl J Med 2011;365:239-50. https://doi.org/10.1056/NEJMra1007755
  17. Lee J, Woo BW, Kim HS. Prognostic factors of renal scarring on follow-up DMSA scan in children with acute pyelonephritis. Child Kidney Dis 2016;20:74-8. https://doi.org/10.3339/jkspn.2016.20.2.74
  18. Seon YS, Kwon DG, Shin YH, Pai KS. Prognostic factors of renal defects on the initial DMSA scan in children with acute pyelonephritis. J Korean Soc Pediatr Nephrol 2010;14:195-202. https://doi.org/10.3339/jkspn.2010.14.2.195