The evaluation of the relationship of clinical and laboratory evidence with renal damage in the pediatric patients that had urinary tract infections

Becerir, Tulay; YUKSEL, SELCUK; seyhan, burçin

doi:10.31362/patd.990677

The evaluation of the relationship of clinical and laboratory evidence with renal damage in the pediatric patients that had urinary tract infections

SELÇUK YÜKSEL, (Pamukkale University Faculty of Medicine, Department of Pediatrics, Department of Pediatric Rheumatology and Pediatric Nephrology, Kinikli Campus, Denizli, Turkey)

Tülay BECERİR, (Pamukkale University Faculty of Medicine, Department of Pediatrics, Department Pediatric Nephrology, Kinikli Campus, Denizli, Turkey)

Burcin Seyhan (Denizli State Hospital, Department of Pediatrics, Denizli, Turkey)

Pamukkale Tıp Dergisi

2 1

Yıl: 2021 Cilt: 14 Sayı: 4 Sayfa Aralığı: 908 - 915 Metin Dili: Türkçe DOI: 10.31362/patd.990677 İndeks Tarihi: 16-05-2022

The evaluation of the relationship of clinical and laboratory evidence with renal damage in the pediatric patients that had urinary tract infections

Öz:

Purpose: Urinary tract infection (UTI) is one of the important infectious diseases of childhood age. It causes serious late-term complications by leading to development of renal scarring in some pediatric patients. In the present study, it was aimed to determine the risk factors in development of renal damage in the pediatric patients that admitted with clinical of acute pyelonephritis. Materials and methods: In our study, the medical files of the patients were admitted to the pediatric nephrology polyclinic of Pamukkale University Medical Faculty and followed-up with the diagnosis of urinary tract infection were retrospectively evaluated. The study included 197 patients diagnosed with acute pyelonephritis (confirmed by urine culture and clinical evidence) and undergoing dimercaptosuccinic acid (DMSA) scintigraphic imaging. The clinical evidence (fever, recurrent UTI, voiding dysfunction etc.), laboratory evidence (C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), white blood cell (WBC) count, polymorphonuclear leukocyte (PNL) count, mean platelet volume (MPV), platelet count, serum urea and creatinine levels) and imaging evidence (urinary tract system ultrasonography (USG), voiding cystourethrography (VCUG) and DMSA scintigraphy) of the patients detected at admission and obtained by anamnesis were evaluated. Results: The number of the female patients (n=153) was found significantly higher than number of the male patients (n=44) (p<0.001). It was detected that pretreatment fever of 38ºC and over, persisting clinical evidence for 2 days or longer, the presence of recurrent UTI and high levels of WBC, PNL, ESR and CRP significantly increased renal damage in the patients (p<0.001). It was determined that USG and VCUG have low sensitivity regarding prediction of renal damage. Conclusion: Determination of renal damage rate by clinical and laboratory data detected at patient admission may contribute to a reduction in morbidity and mortality rates by applying an appropriate follow-up and treatment modality.

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1. Tullus K, Shaikh N. Urinary tract infections in children. Lancet 2020;395:1659-1668. https://doi.org/10.1016/ S0140-6736(20)30676-0
2. Millner R, Becknell B. Urinary tract infections. Pediatr Clin North Am 2019;66:1-13. https://doi.org/10.1016/j. pcl.2018.08.002
3. Foxman B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Am J Med 2002;113;5-13. https://doi.org/10.1016/s0002- 9343(02)01054-9
4. Moorthy I, Easty M, McHung K, Ridout D, Biassoni D, Gordon I. The presence of vesicoureteric reflux does not identify a population at risk for renal scarring following a first urinary tract infection. Arch Dis Child 2005;90:733- 736. https://doi.org/10.1136/adc.2004.057604
5. Yüksel S, Yüksel G, Çakar N. Urinary tract infection in children. T Klin Pediatri 2002;11:41-49.
6. Sinha MD, Gibson P, Kane T, Lewis MA. Accuracy of ultrasonic detection of renal scarring in different centres using DMSA as the gold standart. Nephrol Dial Transplant 2007;22:2213-2216. https://doi. org/10.1093/ndt/gfm155
7. Benador D, Benador N, Slosman D, Mermillod B, Girardin E. Are younger children at highest risk of renal sequelae after pyelonephritis? Lancet 1997;349:17-19. https://doi.org/10.1016/S0140-6736(96)06126-0
8. Jakobsson B, Berg U, Svensson L. Renal scarring after acute pyelonephritis. Arch Dis Child 1994;70:111-115. https://doi.org/10.1136/adc.70.2.111
9. Yüksel S, Çakar N, Çakmak FN, et al. Risk factors of renal damage in children with acut pyelonephritis. Turkiye Klinikleri J Pediatr 2007;16:158-164.
10. Pecile P, Miorin E, Romanello C, et al. Age-related renal paranchymal lesions in children with first febrile urinary tract infections. Pediatrics 2009;124:23-29. https://doi.org/10.1542/peds.2008-1192
11. Hiraoka M, Hashimoto G, Tsuchida S, Tsukahara H, Ohshima Y, Mayumi M. Early treatment of urinary infection prevents renal damage on cortical scintigraphy. Pediatr Nephrol 2003;18:115-118. https:// doi.org/10.1007/s00467-002-1023-y
12. Doganis D, Siafas K, Mavrikou M, et al. Does early treatment of urinary tract infection prevent renal damage? Pediatrics 2007;120:922-928. https://doi. org/10.1542/peds.2006-2417
13. Hewitt IK, Zucchetta P, Rigon L, et al. Early treatment of acute pyelonephritis in children fails to reduce renal scarring: data from the Italian renal ınfection study trials. Pediatrics 2008;122:486-490. https://doi. org/10.1542/peds.2007-2894
14. Smellie JM, Poulton A, Prescod NP. Retrospective study of children with renal scarring associated with reflux and urinary infection. BMJ 1994;308:1193-1196. https://doi.org/10.1136/bmj.308.6938.1193
15. Chang SL, Shortliffe LD. Pediatric urinary tract infections. Pediatr Clin North Am 2006;53:379-400. https://doi.org/10.1016/j.pcl.2006.02.011
16. Garin EH, Olovarria F, Araya C, Broussain M, Barrea C, Young L. Diagnostic significance of clinical and laboratory findings to localize site of urinary infection. Pediatr Nephrol 2007;22:1002-1006. https://doi. org/10.1007/s00467-007-0465-7
17. Lai SW, Ng KC. Retrospective analysis of inflammatory parameters in acute pyelonephritis. Scand J Urol Nephrol 2003;37:250-252. https://doi. org/10.1080/00365590310008145
18. Soylu A, Kasap B, Demir K, Türkmen M, Kavukçu S. Predictive value of clinical and laboratory variables for vesicoureteral reflux in children. Pediatr Nephrol 2007;22:844-848. https://doi.org/10.1007/s00467-006- 0418-6
19. Oostenbrink R, Van der Heijden AJ, Moons KG, Moll HA. Prediction of vesico-ureteric reflux in childhood urinary tract infection: a multivariate approach. Acta Paediatr 2000;89:806-810.
20. Kosmeri C, Kalaitzidis R, Siomou E. An update on renal scarring after urinary tract infection in children: what are the risk factors? J Pediatr Urol 2019;15:598-603. https://doi.org/10.1016/j.jpurol.2019.09.010
21. Spencer JR, Schaeffer AJ. Paediatric urinary tract infections. Urol Clin North Am 1986;13:661-672.
22. Gleeson FV, Gordon I. Imaging in urinary tract infection. Arch Dis Child 1991;66:1282-1283.
23. Kaack MB, Dowling KJ, Patterson GM, Roberts JA. Immunology of pyelonephritis VIII. E. coli causes granulocytic aggregation and renal ischemia. J Urol 1986;136:1117-1122. https://doi.org/10.1016/s0022- 5347(17)45235-9
24. Roberts JA. Mechanisms of renal damage in chronic pyelonephritis (reflux nephropathy). Curr Top Pathol 1995;88:265-287. https://doi.org/10.1007/978-3-642- 79517-6_9
25. Snodgrass WT, Shah A, Yang M, et al. Prevalence and risk factors for renal scars in children with febrile UTI and/or VUR: a cross-sectional observational study of 565 consecutive patients. J Pediatr Urol 2013;9:856- 863. https://doi.org/10.1016/j.jpurol.2012.11.019
26. Ferreiro C, Piepsz A, Nogarède C, Tondeur M, Hainaut M, Levy J. Late renal sequelae in intravenously treated complicated urinary tract infection. Eur J Pediatr 2013;172:1243-1248. https://doi.org/10.1007/s00431- 013-2024-5
27. Keren R, Shaikh N, Pohl H, et al. Risk factors for recurrent urinary tract infection and renal scarring. Pediatrics 2015;136:13-21. https://doi.org/10.1542/ peds.2015-0409
28. Christian MT, McColl JH, MacKenzie JR, Beattie TJ. Risk assesment of renal cortical scarring with urinary tract infection by clinical features and ultrasonography. Arch Dis Child 2000;82:376-380. https://doi. org/10.1136/adc.82.5.376
29. Moorthy I, Wheat D, Gordon I. Ultrasonography in the evaluation of renal scarring using DMSA scan as the gold standard. Pediatr Nephrol 2004;19:153-156. https://doi.org/10.1007/s00467-003-1363-2

APA	YUKSEL S, Becerir T, seyhan b (2021). The evaluation of the relationship of clinical and laboratory evidence with renal damage in the pediatric patients that had urinary tract infections. , 908 - 915. 10.31362/patd.990677
Chicago	YUKSEL SELCUK,Becerir Tulay,seyhan burçin The evaluation of the relationship of clinical and laboratory evidence with renal damage in the pediatric patients that had urinary tract infections. (2021): 908 - 915. 10.31362/patd.990677
MLA	YUKSEL SELCUK,Becerir Tulay,seyhan burçin The evaluation of the relationship of clinical and laboratory evidence with renal damage in the pediatric patients that had urinary tract infections. , 2021, ss.908 - 915. 10.31362/patd.990677
AMA	YUKSEL S,Becerir T,seyhan b The evaluation of the relationship of clinical and laboratory evidence with renal damage in the pediatric patients that had urinary tract infections. . 2021; 908 - 915. 10.31362/patd.990677
Vancouver	YUKSEL S,Becerir T,seyhan b The evaluation of the relationship of clinical and laboratory evidence with renal damage in the pediatric patients that had urinary tract infections. . 2021; 908 - 915. 10.31362/patd.990677
IEEE	YUKSEL S,Becerir T,seyhan b "The evaluation of the relationship of clinical and laboratory evidence with renal damage in the pediatric patients that had urinary tract infections." , ss.908 - 915, 2021. 10.31362/patd.990677
ISNAD	YUKSEL, SELCUK vd. "The evaluation of the relationship of clinical and laboratory evidence with renal damage in the pediatric patients that had urinary tract infections". (2021), 908-915. https://doi.org/10.31362/patd.990677

APA	YUKSEL S, Becerir T, seyhan b (2021). The evaluation of the relationship of clinical and laboratory evidence with renal damage in the pediatric patients that had urinary tract infections. Pamukkale Tıp Dergisi, 14(4), 908 - 915. 10.31362/patd.990677
Chicago	YUKSEL SELCUK,Becerir Tulay,seyhan burçin The evaluation of the relationship of clinical and laboratory evidence with renal damage in the pediatric patients that had urinary tract infections. Pamukkale Tıp Dergisi 14, no.4 (2021): 908 - 915. 10.31362/patd.990677
MLA	YUKSEL SELCUK,Becerir Tulay,seyhan burçin The evaluation of the relationship of clinical and laboratory evidence with renal damage in the pediatric patients that had urinary tract infections. Pamukkale Tıp Dergisi, vol.14, no.4, 2021, ss.908 - 915. 10.31362/patd.990677
AMA	YUKSEL S,Becerir T,seyhan b The evaluation of the relationship of clinical and laboratory evidence with renal damage in the pediatric patients that had urinary tract infections. Pamukkale Tıp Dergisi. 2021; 14(4): 908 - 915. 10.31362/patd.990677
Vancouver	YUKSEL S,Becerir T,seyhan b The evaluation of the relationship of clinical and laboratory evidence with renal damage in the pediatric patients that had urinary tract infections. Pamukkale Tıp Dergisi. 2021; 14(4): 908 - 915. 10.31362/patd.990677
IEEE	YUKSEL S,Becerir T,seyhan b "The evaluation of the relationship of clinical and laboratory evidence with renal damage in the pediatric patients that had urinary tract infections." Pamukkale Tıp Dergisi, 14, ss.908 - 915, 2021. 10.31362/patd.990677
ISNAD	YUKSEL, SELCUK vd. "The evaluation of the relationship of clinical and laboratory evidence with renal damage in the pediatric patients that had urinary tract infections". Pamukkale Tıp Dergisi 14/4 (2021), 908-915. https://doi.org/10.31362/patd.990677