Association of Renal Scarring With Number of Febrile Urinary Tract Infections in Children
Association of Renal Scarring With Number of Febrile Urinary Tract Infections in Children
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DOI：
10.1001/jamapediatrics.2019.2504
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发表时间：
2019-10-01
期刊：
影响因子：
26.1
通讯作者：
Hoberman, Alejandro
中科院分区：
文献类型：
--
作者：
Shaikh, Nader;Haralam, Mary Ann;Hoberman, Alejandro
重要性虽然先前的研究表明肾瘢痕形成的风险随着每次发热性尿路感染（UTI）而逐渐增加，但缺乏最近的详细数据。对2018年6月至2019年4月在2项多中心前瞻性研究背景下收集的数据进行了事后分析（2007年6月至2013年6月进行的RIVUR [膀胱输尿管反流儿童随机干预]和2008年5月至2013年10月进行的CUTIE [仔细尿路感染评估]），的第一次UTI没有基线肾脏异常的儿童随访2年的发热复发。暴露已知发热UTI的数量。主要结果和测量肾瘢痕形成被定义为与锝99 m二巯基琥珀酸的轮廓损失或皮质变薄相关的示踪剂摄取减少。结果共纳入345名儿童（307名女孩和38名男孩;平均[SD]年龄，19.4 [18.2]个月; 221名有膀胱输尿管反流，124名无膀胱输尿管反流）。1次发热性UTI后肾瘢痕形成的发生率为2.8%（95% CI，1.2%-5.8%），2次发热性UTI后为25.7%（95% CI，12.5%-43.3%），3次或以上发热性UTI后为28.6%（95% CI，8.4%-58.1%）。第二次发热性感染后肾瘢痕形成的几率为11.8（95%CI，4.1-34.4）倍，3次或3次以上发热性感染后肾瘢痕形成的几率为13.7（95%CI，3.4-54.4）倍。结论和相关性虽然相对较少的儿童有2个发热性UTI，与单纯发热性尿路感染的儿童相比，那些确实有肾瘢痕形成的风险显著更高。这一发现表明，研究应该集中在确定生物标志物，可以非侵入性地确定儿童在随后的发热感染的风险。还需要更多的研究来了解复发性发热性尿路感染儿童肾瘢痕形成风险增加的分子基础。
IMPORTANCE Although prior studies have suggested that the risk of renal scarring gradually increases with each febrile urinary tract infection (UTI), recent and detailed data are lacking.OBJECTIVE To evaluate how the risk of renal scarring is associated with the number of febrile UTIs.DESIGN, SETTING, AND PARTICIPANTS A post hoc analysis was performed from June 2018 to April 2019 of data collected in the context of 2 multicenter prospective studies (RIVUR [Randomized Intervention for Children With Vesicoureteral Reflux], conducted from June 2007 to June 2013, and CUTIE [Careful Urinary Tract Infection Evaluation], conducted from May 2008 to October 2013), of children with a first UTI without baseline renal abnormalities who were followed up for 2 years for febrile recurrences.EXPOSURE Number of known febrile UTIs.MAIN OUTCOMES AND MEASURES Renal scarring was defined as decreased uptake of tracer associated with the loss of contours or cortical thinning on a technetium 99m dimercaptosuccinic acid renal scan obtained at study exit or approximately 4 months after the last febrile UTI.RESULTS A total of 345 children were included (307 girls and 38 boys; mean [SD] age, 19.4 [18.2] months; 221 with vesicoureteral reflux and 124 without vesicoureteral reflux). The incidence of renal scarring was 2.8% (95% CI, 1.2%-5.8%) after 1 febrile UTI, 25.7% (95% CI, 12.5%-43.3%) after 2 febrile UTIs, and 28.6% (95% CI, 8.4%-58.1%) after 3 or more febrile UTIs. The odds of renal scarring after a second febrile infection were 11.8 (95% CI, 4.1-34.4) times greater than after a single febrile infection, and the odds of renal scarring after 3 or more febrile infections were 13.7 (95% CI, 3.4-54.4) times greater than after a single febrile infection.CONCLUSIONS AND RELEVANCE Although relatively few children have 2 febrile UTIs, those who do have a substantially higher risk of renal scarring compared with children with a single febrile UTI. This finding suggests that research should focus on the identification of biomarkers that could noninvasively identify children at risk for subsequent febrile infections. More research is also needed to understand the molecular basis of the increased risk of renal scarring among children with recurrent febrile UTIs.