Risk Factors for Recurrent Urinary Tract Infection and Renal Scarring

Keren, Ron; Shaikh, Nader; Pohl, Hans G.; Gravens-Mueller, Lisa; Ivanova, Anastasia; Zaoutis, Lisa B.; Patel, Melissa; DeBerardinis, Ralph J.; Parker, Allison; Bhatnagar, Sonika; Haralam, Mary Ann; Pope, Marcia A.; Kearney, Diana H.; Sprague, Bruce M.; Barrera, Raquel Morales; Viteri, Bernarda; Egigueron, Martina; Shah, Neha; Hoberman, Alejandro

doi:10.1542/peds.2015-0409

Cited by 252 publications

(180 citation statements)

References 37 publications

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“…Children with BBD and any degree of VUR have the highest risk of recurrent febrile UTI (56%). 21 Additionally, VUR may take longer to resolve on its own in the presence of BBD. 2,21,22 If VUR is diagnosed in a toilet-trained child, BBD must be ruled out and treated before considering surgical repair.…”

Section: Diagnostic Approachmentioning

confidence: 99%

Bladder and bowel dysfunction in children: An update on the diagnosis and treatment of a common, but underdiagnosed pediatric problem

Santos

Lopes

Koyle

2017

CUAJ

138

126

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Bladder and bowel dysfunction (BBD) describes a spectrum of lower urinary symptoms (LUTS) accompanied by fecal elimination issues that manifest primarily by constipation and/or encopresis. This increasingly common entity is a potential cause of significant physical and psychosocial burden for children and families. BBD is commonly associated with vesicoureteral reflux (VUR) and recurrent urinary tract infections (UTIs), which at its extreme may lead to renal scarring and kidney failure. Additionally, BBD is frequently seen in children diagnosed with behavioural and neuropsychiatric disorders such as attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Patients with concomitant BBD and neuropsychiatric disorders have less favourable treatment outcomes. Early diagnosis and treatment of BBD are critical to avoid secondary comorbidities that can adversely impact children's kidney and bladder function, and psychosocial well-being. The majority of patients will improve with urotherapy, adequate fluid intake, and constipation treatment. Pharmacological treatment must only be considered if no improvement occurs after intensive adherence to at least six months of urotherapy ± biofeedback and constipation treatment. Anticholinergics remain the mainstay of medical treatment. Selective alpha-blockers appear to be effective for improving bladder emptying in children with non-neurogenic detrusor overactivity (DO), incontinence, recurrent UTIs, and increased post-void residual (PVR) urine volumes. Alpha-1 blockers can also be used in combination with anticholinergics when overactive bladder (OAB) coexists with functional bladder outlet obstruction. Minimally invasive treatment with onabotulinumtoxinA bladder injections, and recently neurostimulation, are promising alternatives for the management of BBD refractory to behavioural and pharmacological treatment.In this review, we discuss clinical presentation, diagnostic approach, and indications for behavioural, pharmacological, and surgical treatment of BBD in children based on a thorough literature review. Expert opinion will be used when scientific evidence is unavailable.

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Section: Diagnostic Approachmentioning

confidence: 99%

Bladder and bowel dysfunction in children: An update on the diagnosis and treatment of a common, but underdiagnosed pediatric problem

Santos

Lopes

Koyle

2017

CUAJ

138

126

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“…Este amplio rango de variación podría deberse a la inclusión de poblaciones diferentes en edad, sexo y presencia de anomalías (15).…”

Section: Discussionunclassified

“…Según la literatura, la edad, el retraso mayor de 72 horas en el inicio del tratamiento, la presencia de fiebre y de RVU sobre todo de altos grados, se asocia (6) (14) con la aparición de cicatrices renales. Sin embargo, también podrían intervenir otros factores como la como la susceptibilidad genética, la (15) virulencia bacteriana y la defensa del huésped.…”

Section: Discussionunclassified

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Risk factors for kidney damage in pediatric patients with recurrent urinary tract infections

Troche¹,

Pico²,

Basabe³

et al. 2017

Pediatr. (Asunción)

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was a retrospective, cohort study of patients <10 years with ITUR, who consulted as outpatients at the Social Security Institute Hospital and private clinics from January 2015 to July 2017. For our statistical analysis, patients were categorized in two groups according to whether or not they presented kidney damage. The correlation between kidney damage and age, sex, number of urinary tract infection episodes and the presence of vesicoureteral reflux (VUR) was established. For each variable, the relative risk (RR) with a confidence interval of 95% was calculated using Microsoft Excel 2010. Results: 112 patients presented ITUR, the average age was 41.8 months (SD: ± 38.1), M / F ratio: 1: 6. The average number of episodes of UTI per patient was 3.5 (SD ± 1.9). 82/112 (73.2%) had sphincter control and 30/112 (26.7%) did not. Constipation, urinary urgency, incontinence, urinary retention were reported concomitantly in 38%, 48%, 33% and 20% of patients, respectively. The pathologies associated with ITUR were: lower urinary tract dysfunction in 45.5%, vesicoureteral reflux in 37% and hypercalciuria in 16.7%. The sensitivity and specificity of ultrasound to diagnose VUR were 22.7% and 87% respectively. 27/112 (24%) presented kidney damage. The factors associated with kidney damage were age <12 months (p = 0.027, OR 1.2-9, RR 2.2 (95% CI 1.1-4)),> 2 episodes of UTI (p = 0.0005 , OR 1.9-12, RR 3.2 (IC95% 1.6-

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“…1,2 It is a common reason for consultation at the departments of Pediatric Nephrology, General Pediatrics, Pediatric Surgery or Pediatric Urology.…”

Section: Introductionmentioning

confidence: 99%

Impact of using an evidence-based clinical guideline for the management of primary vesicoureteral reflux in children

et al. 2017

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Objective: To analyze changes in the therapeutic approach at a tertiary care hospital following the implementation of a clinical guideline for the treatment of primary vesicoureteral reflux (VUR) in children. Population and methods: Retrospective study conducted in a cohort of patients with primary VUR aged 0-15 years at a tertiary care hospital. The therapeutic approach before and after the development of the clinical guideline (2008) was compared. Results: A total of 297 patients (49.8% boys, 50.2% girls) were included; their mean age at the time of diagnosis was 21.71 months. VUR grading was: VUR I-III 45.1%, VUR IV-V 54,9%; 124 were treated after the implementation of the clinical guideline (group 1), and 173, before (group 2). The mean follow-up period was 124.32 months. A conservative approach was the initial treatment in 70.3% of group 1 patients and 67.9% of group 2 patients. The number of surgeries remains constant (31.45% versus 31.79%), with an increase in the number of endoscopic surgeries (p < 0.005). The profile of patients has changed based on the application of the algorithm proposed by the guideline. Fewer surgeries were done in patients with VUR IV-V (82.32% versus 59.9%, p= 0.000) and there were fewer cases of kidney damage at diagnosis (49.4% versus 9.8%, p= 0.000). Conclusions:The implementation of the clinical guideline has favored an initially conservative approach in patients with severe grade VUR and nephropathy, for whom surgery was traditionally indicated initially. Using clinical guidelines favors a unanimous, evidencebased approach that reduces the performance of unnecessary invasive procedures.

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Risk Factors for Recurrent Urinary Tract Infection and Renal Scarring

Cited by 252 publications

References 37 publications

Bladder and bowel dysfunction in children: An update on the diagnosis and treatment of a common, but underdiagnosed pediatric problem

Bladder and bowel dysfunction in children: An update on the diagnosis and treatment of a common, but underdiagnosed pediatric problem

Risk factors for kidney damage in pediatric patients with recurrent urinary tract infections

Impact of using an evidence-based clinical guideline for the management of primary vesicoureteral reflux in children

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