Predicting factors of clinically significant urological anomalies after initial urinary tract infection among 2‐ to 24‐month‐old children

Abstract

Aim: To find more effective criteria to identify clinically significant urological anomalies after initial urinary tract infection among children. Methods:Children aged 2-24 months with an initial urinary tract infection were consecutively recruited in a Japanese hospital from 2013 to 2019. Voiding cystourethrography, 99mTc dimercaptosuccinic acid scan and ultrasound were intended to perform for all cases. Clinically significant urological anomalies were defined as high-grade vesicoureteral reflux, obstructive and abnormal urinary tract lesions, need for surgical intervention, renal hypoplasia and scarring. Using classification and regression tree analysis, we sought the associated factors. We developed new criteria with these factors, retrospectively applied them to the original data, and calculated the sensitivity and specificity.Results: One hundred sixty-seven patients were eligible, and 39 had clinically significant urological anomalies. Classification and regression tree analysis showed that the associated factors were non-E. coli infections, serum creatinine levels and ultrasound abnormalities. When the gold standards were performed on children with non-E. coli infections or serum creatinine levels ≥0.21 mg/dl, sensitivity and specificity were 0.82 and 0.68, respectively. Conclusion:The criteria including non-E. coli infections and high-normal or higher serum creatinine levels may efficiently predict clinically significant urological anomalies after initial urinary tract infections.

Prevalence, Pathogenic Bacterial Profile and Antimicrobial Susceptibility Pattern of Urinary Tract Infection Among Children with Congenital Anomalies of the Kidney and Urinary Tract

“…The purposes of UTI in childhood often consist of eradication of the bacterial pathogen, identification of CAKUT, and avoidance of recurrent infections. 10 Prompt diagnosis and appropriate treatment are very important for children to reduce the morbidity.…”

NUM‐score: A clinical‐analytical model for personalised imaging after urinary tract infections

“…Another parameter strongly related to malformations is infection with a non‐ E. coli pathogen 10,11,21 . In our study, having an infection with an atypical pathogen increased the probability of underlying malformations by four times.…”

“…19 Different studies have identified various risk factors associated with NUM, and some heterogeneous recommendations have been made based on these criteria. 10,11,20,21 However, until now, there has yet to be a predictive model with good predictive capacity, based solely on clinical and analytical parameters, capable of stratifying patients into risk groups for individualised imaging protocols.…”

“…Some clinical guidelines, like KHA‐CARI, 8 the Swiss Consensus Document, 4 or NICE‐guidelines 6 mention elevated creatinine as an indication for imaging tests (RBUS or VCUG) but do not establish a specific threshold for significance. A Japanese study 11 linked creatinine >0.21 mg/dL to urological issues. However, these levels match standard creatinine values in healthy Japanese children.…”

“…9 Amidst this controversy, various urinary tract malformation markers have been proposed to assist clinicians in identifying patients who may require additional diagnostic testing. [10][11][12] This introduction sets the stage for our study, which explores a clinicalanalytical model designed to address these challenges, focusing on predictive variables to optimise the diagnostic process through imaging tests.…”