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Rosenblad T, Lindén M, Ambite I, Brandström P, Hansson S, Godaly G. Genetic determinants of renal scarring in children with febrile UTI. Pediatr Nephrol 2024; 39:2703-2715. [PMID: 38767678 PMCID: PMC11272715 DOI: 10.1007/s00467-024-06394-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Febrile urinary tract infections (UTIs) are among the most severe bacterial infections in infants, in which a subset of patients develops complications. Identifying infants at risk of recurrent infections or kidney damage based on clinical signs is challenging. Previous observations suggest that genetic factors influence UTI outcomes and could serve as predictors of disease severity. In this study, we conducted a nationwide survey of infant genotypes to develop a strategy for infection management based on individual genetic risk. Our aims were to identify genetic susceptibility variants for renal scarring (RS) and genetic host factors predisposing to dilating vesicoureteral reflux (VUR) and recurrent UTIs. METHODS To assess genetic susceptibility, we collected and analyzed DNA from blood using exome genotyping. Disease-associated genetic variants were identified through bioinformatics analysis, including allelic frequency tests and odds ratio calculations. Kidney involvement was defined using dimercaptosuccinic acid (DMSA) scintigraphy. RESULTS In this investigation, a cohort comprising 1087 infants presenting with their first episode of febrile UTI was included. Among this cohort, a subset of 137 infants who underwent DMSA scanning was subjected to gene association analysis. Remarkable genetic distinctions were observed between patients with RS and those exhibiting resolved kidney involvement. Notably, the genetic signature indicative of renal scarring prominently featured mitochondrial genes. CONCLUSIONS In this nationwide study of genetic susceptibility to RS after febrile UTIs in infancy, we identified a profile dominated by mitochondrial polymorphisms. This profile can serve as a predictor of future complications, including RS and recurrent UTIs.
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Affiliation(s)
- Therese Rosenblad
- Section for Pediatric Nephrology, Skåne University Hospital, Lund, Sweden
| | - Magnus Lindén
- Department of Pediatrics, Halland Hospital, Halmstad, Sweden
| | - Ines Ambite
- Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Per Brandström
- Pediatric Uro-Nephrology Centre, Queen Silvia's Children's Hospital, Gothenburg, Sweden
| | - Sverker Hansson
- Pediatric Uro-Nephrology Centre, Queen Silvia's Children's Hospital, Gothenburg, Sweden
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gabriela Godaly
- Department of Laboratory Medicine, Lund University, Lund, Sweden.
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Lindén M, Rosenblad T, Rosenborg K, Hansson S, Brandström P. Infant urinary tract infection in Sweden - A national study of current diagnostic procedures, imaging and treatment. Pediatr Nephrol 2024:10.1007/s00467-024-06415-4. [PMID: 39008116 DOI: 10.1007/s00467-024-06415-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/29/2024] [Accepted: 05/15/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Urinary tract infection (UTI) in infants is a common, potentially life-threatening bacterial infection, and must be managed carefully through the entire chain of care from diagnosis, choice of treatment, follow-up and risk stratification of future complications. This Swedish nationwide study of infant UTI was conducted to evaluate the current management of infant UTI, yield of investigations and the Swedish UTI guidelines' ability to detect abnormalities of importance in the urinary tract. METHODS Infants < 1 year with a first episode of UTI were included in a prospective multicenter study. Treatment and follow-up were provided by local pediatricians. Clinical and laboratory findings and imaging results were reported to the coordinating center. The current management and results were compared with a previous Swedish study. RESULTS One thousand three hundred six infants were included. Urine sampling was performed with clean catch technique in 93% of patients. Initial oral antibiotic treatment was used in 63%, predominantly third generation cephalosporines. Permanent kidney abnormalities were found in 10% and dilating vesicoureteral reflux (VUR) in 8%. Higher rates of male gender, non-E. coli infection and ultrasound dilatation were seen in infants < 1 month. UTI recurrences were reported in 18%. CONCLUSIONS Infant UTI is still generating a considerable amount of follow-up examinations. There is a significant shift towards clean catch as the main urine sampling method. Voiding cystourethrography is performed less frequently reducing the findings of low grade VUR. The incidence of renal scarring is comparable with earlier studies which suggests that the Swedish guidelines are able to identify individuals with risk for long-term complications.
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Affiliation(s)
- Magnus Lindén
- Department of Pediatrics, Halland Hospital, Halmstad, Sweden.
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Therese Rosenblad
- Department of Pediatrics, Lund Children's Hospital, Lund, Sweden
- Division of Microbiology, Immunology and Glycobiology, Institute of Laboratory Medicine, Lund University, Lund, Sweden
| | - Karin Rosenborg
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Sverker Hansson
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Pediatric Uro-Nephrology Center, The Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Per Brandström
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Pediatric Uro-Nephrology Center, The Queen Silvia Children's Hospital, Gothenburg, Sweden
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Okada M, Kijima E, Yamamura H, Nakatani H, Yokoyama H, Imai M, Suzuki N, Oshiba A, Nagasawa M. Obesity and febrile urinary tract infection in young children. Pediatr Int 2022; 64:e14686. [PMID: 33682248 DOI: 10.1111/ped.14686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 02/14/2021] [Accepted: 03/01/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Obesity is a risk factor for infectious diseases. However, the relationship between obesity and febrile urinary tract infection (fUTI) is controversial. This study aimed to determine the relationship between obesity and fUTI in young children. METHODS We analyzed the medical records of children aged <2 years who were admitted to our hospital because of fever between April 2013 to March 2018. The children were categorized into three groups of non-obese, overweight, and obese according to the World Health Organization weight-for-length curves for children aged <2 years. RESULTS A total of 600 patients were enrolled in this study, of whom 118 were diagnosed with first fUTI. Patients in the fUTI group were younger than those in the control group (patients who were diagnosed with other febrile diseases) (5 ± 5.11 vs 11 ± 6.53 months; P < 0.001). There were no significant differences in the populations of overweight and obese children between the fUTI and control groups. In the fUTI group, the duration of fever, types of pathogen, recurrent rate, the grades of vesicoureteral reflux, and renal scarring were not associated with obesity. The white blood cell count and C-reactive protein levels were not significantly different among the three weight-for-length categories. The same results were obtained when the fUTI group was compared with an age-matched control group (n = 192, 4 ± 2.55 months old; P = 0.261). CONCLUSIONS Obesity is not a significant risk factor for fUTI in febrile hospitalized young children. Our study suggests that conducting urinalysis for febrile young children without obvious sources, irrespective of obesity, should be considered.
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Affiliation(s)
- Mari Okada
- Department of Pediatrics, Musashino Red Cross Hospital, Musashino, Tokyo, Japan
| | - Emi Kijima
- Department of Pediatrics, Musashino Red Cross Hospital, Musashino, Tokyo, Japan
| | - Haruka Yamamura
- Department of Pediatrics, Musashino Red Cross Hospital, Musashino, Tokyo, Japan
| | - Hisae Nakatani
- Department of Pediatrics, Musashino Red Cross Hospital, Musashino, Tokyo, Japan
| | - Haruna Yokoyama
- Department of Pediatrics, Musashino Red Cross Hospital, Musashino, Tokyo, Japan
| | - Masako Imai
- Department of Pediatrics, Musashino Red Cross Hospital, Musashino, Tokyo, Japan
| | - Natsuko Suzuki
- Department of Pediatrics, Musashino Red Cross Hospital, Musashino, Tokyo, Japan
| | - Akihiro Oshiba
- Department of Pediatrics, Musashino Red Cross Hospital, Musashino, Tokyo, Japan
| | - Masayuki Nagasawa
- Department of Pediatrics, Musashino Red Cross Hospital, Musashino, Tokyo, Japan
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Simičić Majce A, Arapović A, Čapkun V, Brdar D, Brekalo M, Zebić I, Barić A, Punda A, Saraga-Babić M, Vukojević K, Saraga M. The Spectrum of Parenchymal Changes in Kidneys Affected by Intrarenal Reflux, Diagnosed by Contrast-Enhanced Voiding Urosonography and DMSA Scan. Front Pediatr 2022; 10:886112. [PMID: 35899129 PMCID: PMC9309385 DOI: 10.3389/fped.2022.886112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/08/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To describe the parenchymal defects in kidneys with intrarenal reflux (IRR) diagnosed using contrast-enhanced voiding urosonography (ceVUS) and 99mTc-DMSA scintigraphy (DMSA scan). MATERIALS AND METHODS A group of 186 uretero-renal units (URUs) was analyzed using ceVUS and DMSA scans: 47 without vesicoureteral reflux (VUR) (group A) and 139 with VURs, comprising 73 VURs without (group B), and 66 with IRR (group C). VURs included non-dilating (grades I-II), mildly non-dilating (grade III), and non-dilating (grades IV-V) grades. The parenchymal changes were analyzed using a DMSA scan. RESULTS The median age for VUR diagnosis was 16.5 months in girls, and 8.5 months in boys (Z = 3.9; p = 0.001). IRR occurred in 51.4% of boys and in 25.9% of girls (χ2 = 12.4; p < 0.001). The non-dilating VUR occurred in 44% of boys and 24.1% of girls (χ2 = 7.7; p = 0.005). IRRs characterized upper and lower renal segments (81.8 and 63.6%) and middle segments (33.3%). Both incidence and increase in IRR correlated with the grade of VUR (p < 0.001). The incidence of reduced DMSA signal was statistically different among groups A + B and C, but not between groups A and B (χ2 = 32.2; p < 0.001). No statistically significant relationship existed between the reduced DMSA signal and the grade of VUR in group C. The reduced DMSA signal appeared in 9.9% positions in kidneys from group A, 14% from group B, and 32% from group C. Out of all 118 IRRs, 38.1% had reduced and 61.9% had normal DMSA signal. Among 11 parenchymal scars found in all three groups, 2 belonged to group B, 9 to group C, while group A had no scars. CONCLUSION The parenchymal changes are the most prominent in the group with IRR, but they do not significantly differ among kidneys with different grades of VUR. VURs of higher grades are associated with a higher incidence of IRR and early clinical presentation. Scars can also appear in lower-grade VURs accompanied by IRR. Boys with VUR have earlier clinical presentation than girls, as they have significantly higher grades of VUR with a higher proportion of IRRs. Therefore, we suggest a subdivision of VURs into those with IRR and abundant parenchymal damage, and those without IRR and less parenchymal damage.
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Affiliation(s)
| | - Adela Arapović
- Department of Pediatrics, University Hospital Split, Split, Croatia
| | - Vesna Čapkun
- Department of Nuclear Medicine, University Hospital Split, Split, Croatia
| | - Dubravka Brdar
- Department of Nuclear Medicine, University Hospital Split, Split, Croatia
| | - Marko Brekalo
- Department of Nuclear Medicine, University Hospital Split, Split, Croatia
| | - Ileana Zebić
- Department of Nuclear Medicine, University Hospital Split, Split, Croatia
| | - Ana Barić
- Department of Nuclear Medicine, University Hospital Split, Split, Croatia
| | - Ante Punda
- Department of Nuclear Medicine, University Hospital Split, Split, Croatia.,School of Medicine, University of Split, Split, Croatia
| | - Mirna Saraga-Babić
- Department of Anatomy, Histology and Embryology, School of Medicine, University of Split, Split, Croatia
| | - Katarina Vukojević
- Department of Anatomy, Histology and Embryology, School of Medicine, University of Split, Split, Croatia
| | - Marijan Saraga
- Department of Pediatrics, University Hospital Split, Split, Croatia.,School of Medicine, University of Split, Split, Croatia
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YÜKSEL S, BECERİR 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 MEDICAL JOURNAL 2021:908-915. [DOI: 10.31362/patd.990677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
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Peñalver Penedo R, Rupérez Lucas M, Álvarez-Sala Walther LA, Torregrosa Benavent A, Casas Losada ML, Bañuelos Andrio L, Rebolledo Poves AB, Bueno Campaña M. MR-Proadrenomedullin as biomarker of renal damage in urinary tract infection in children. BMC Pediatr 2021; 21:292. [PMID: 34187408 PMCID: PMC8240321 DOI: 10.1186/s12887-021-02765-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 06/02/2021] [Indexed: 01/18/2023] Open
Abstract
Background Midregional-proadrenomedullin (MR-proADM) is a useful prognostic peptide in severe infectious pathologies in the adult population. However, there are no studies that analyze its utility in febrile urinary tract infection (fUTI) in children. An accurate biomarker would provide an early detection of patients with kidney damage, avoiding other invasive tests like renal scintigraphy scans. Our objective is to study the usefulness of MR-proADM as a biomarker of acute and chronic renal parenchymal damage in fUTI within the pediatric population. Methods A prospective cohort study was conducted in pediatric patients with fUTI between January 2015 and December 2018. Plasma and urine MR-proADM levels were measured at admission in addition to other laboratory parameters. After confirmation of fUTI, renal scintigraphy scans were performed during the acute and follow-up stages. A descriptive study has been carried out and sensitivity, specificity and ROC curves for MR-proADM, C-reactive protein, and procalcitonin were calculated. Results 62 pediatric patients (34 female) were enrolled. Scintigraphy showed acute pyelonephritis in 35 patients (56.5%). Of those patients, the median of plasmatic MR-proADM (P-MR-proADM) showed no differences compared to patients without pyelonephritis. 7 patients (11.3%) developed renal scars (RS). Their median P-MR-proADM levels were 1.07 nmol/L (IQR 0.66–1.59), while in patients without RS were 0.48 nmol/L (0.43–0.63) (p < 0.01). The AUC in this case was 0.92 (95% CI 0.77–0.99). We established an optimal cut-off point at 0.66 nmol/L with sensitivity 83.3% and specificity 81.8%. Conclusion MR-ProADM has demonstrated a poor ability to diagnose pyelonephritis in pediatric patients with fUTI. However, P-MR-proADM proved to be a very reliable biomarker for RS prediction. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02765-2.
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Affiliation(s)
- Rafael Peñalver Penedo
- Servicio de Pediatría, Hospital Santa Bárbara de Soria, Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
| | - Marta Rupérez Lucas
- Servicio de Pediatría, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Luis Antonio Álvarez-Sala Walther
- Departamento de Medicina, Facultad de Medicina, Servicio de Medicina Interna, Hospital General Universitario Gregorio Marañón, IiSGM, Instituto de Investigaciones Sanitarias Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | | | | | - Luis Bañuelos Andrio
- Servicio de Medicina Nuclear, Hospital Universitario Fundación Alcorcón, Madrid, Spain
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Arapović A, Punda A, Brdar D, Čapkun V, Bajo D, Veljačić D, Punda H, Simičić-Majce A, Saraga-Babić M, Vukojević K, Saraga M. Types of Parenchymal Changes Diagnosed on DMSA Scans of Kidneys Affected by Different Grades of Vesicoureteral Reflux. Med Sci Monit 2021; 27:e929617. [PMID: 33647007 PMCID: PMC7934341 DOI: 10.12659/msm.929617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Renal parenchymal damage and scarring usually is associated with urinary tract infection (UTI), whereas the impact of vesicoureteral reflux (VUR) on the kidneys is unclear. We aimed to compare kidneys with all grades of VUR (grades Io-V) and those without VUR by using direct radionuclide cystography, voiding cystourethrography, and findings from 99mTc-DMSA scintigraphy (DMSA scan). Material/Methods The present analysis included 253 renal ureteral units (RUU) from 129 children with VUR and recurrent UTI and children with a single febrile UTI associated with abnormal ultrasonographic findings. The 6 grades of VUR (Io, I, II, III, IV, and V) and 35 RUUs without VUR were divided into 4 groups: 1. Non-dilated VUR (grades Io-II); 2. Mildly dilated VUR (grade III); 3. Dilated VUR (grades IV–V); and 4. The control group. Results DMSA scanning showed significant differences between the groups with non-dilated VUR, grade III VUR, grades IV–V VUR, and the control group in kidney width (χ2=30.5; P<0.001); position and shape (χ2=30.6; P<0.001); intensity of activity (χ2=38.1; P<0.001); distribution of activity (χ2=34.5; P<0.001); and existence of scars (χ2=16; P<0.001). The probability of abnormalities on DMSA scans increased with the VUR grade. However, inside the groups of dilated and non-dilated VUR we found no significant statistical differences between those characteristics. Conclusions Our results indicate that kidneys without VUR or with non-dilated lateral VUR and dilated VUR on the contralateral side represent 2 different categories of parenchymal changes.
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Affiliation(s)
- Adela Arapović
- Department of Pediatrics, University Hospital in Split, Split, Croatia
| | - Ante Punda
- School of Medicine, University of Split, Split, Croatia
| | - Dubravka Brdar
- Department of Nuclear Medicine, University Hospital in Split, Split, Croatia
| | - Vesna Čapkun
- Department of Nuclear Medicine, University Hospital in Split, Split, Croatia
| | - Diana Bajo
- Department of Rheumatology and Clinical Immunology, University Hospital in Split, Split, Croatia
| | - Daniela Veljačić
- Department of Pediatrics, University Hospital in Split, Split, Croatia
| | - Hrvoje Punda
- Department of Radiology, University Hospital in Split, Split, Croatia
| | - Ana Simičić-Majce
- Department of Pediatrics, University Hospital in Split, Split, Croatia
| | - Mirna Saraga-Babić
- Department of Anatomy, Histology and Embryology, School of Medicine, University of Split, Split, Croatia
| | - Katarina Vukojević
- Department of Anatomy, Histology and Embryology, School of Medicine, University of Split, Split, Croatia
| | - Marijan Saraga
- Department of Pediatrics, University Hospital in Split, Split, Croatia.,School of Medicine, University of Split, Split, Croatia
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