背景:儿童尿路感染(UTI)可导致肾脏疤痕,可能还有高血压,慢性肾脏病(CKD),和终末期肾衰竭(ESRF)。以前的研究集中在选定的人群中,患有严重疾病或潜在危险因素。大多数患有UTI的儿童的风险尚不清楚。
目的:在未选择的儿童群体中,研究儿童UTI与结局之间的关联。
方法:一项基于人群的回顾性队列研究,使用连锁GP,医院,和威尔士的微生物学记录,英国。
方法:参与者均为2005-2009年出生的儿童,随访至2017年12月31日。该暴露在5岁之前是微生物学证实的UTI。主要结局指标是肾脏瘢痕形成,高血压,CKD,和ESRF。
结果:总计,其中包括159名201名儿童;77524名(48.7%)为女性,7%(n=11099)在5岁之前患有UTI。到7岁时,共有0.16%(n=245)被诊断出患有肾脏疤痕。到7岁患有UTI的儿童,肾脏瘢痕形成的几率更高(1.24%;调整后的比值比4.60[95%置信区间[CI]=3.33至6.35])。平均随访时间为9.53年。调整后的风险比为:高血压为1.44(95%CI=0.84至2.46);CKD为1.67(95%CI=0.85至3.31);ESRF为1.16(95%CI=0.56至2.37)。
结论:在未选择的UTI儿童人群中,肾脏瘢痕形成的患病率较低。没有潜在的风险因素,UTI与CKD无关,高血压,或ESRF到10岁。对儿童肾脏进行系统扫描的进一步研究,包括那些不太严重的UTI和没有UTI的,需要增加这些结果的确定性,因为大多数孩子没有扫描。需要更长时间的随访来确定UTI,没有额外的风险因素,与高血压有关,CKD,或ESRF以后的生活。
BACKGROUND: Childhood urinary tract infection (UTI) can cause renal scarring, and possibly hypertension, chronic kidney disease (CKD), and end-stage renal failure (ESRF). Previous studies have focused on selected populations, with severe illness or underlying risk factors. The risk for most children with UTI is unclear.
OBJECTIVE: To examine the association between childhood UTI and outcomes in an unselected population of children.
METHODS: A retrospective population-based cohort study using linked GP, hospital, and microbiology records in Wales, UK.
METHODS: Participants were all children born in 2005-2009, with follow-up until 31 December 2017. The exposure was microbiologically confirmed UTI before the age of 5 years. The key outcome measures were renal scarring, hypertension, CKD, and ESRF.
RESULTS: In total, 159 201 children were included; 77 524 (48.7%) were female and 7% (n = 11 099) had UTI before the age of 5 years. A total of 0.16% (n = 245) were diagnosed with renal scarring by the age of 7 years. Odds of renal scarring were higher in children by age 7 years with UTI (1.24%; adjusted odds ratio 4.60 [95% confidence interval [CI] = 3.33 to 6.35]). Mean follow-up was 9.53 years. Adjusted hazard ratios were: 1.44 (95% CI = 0.84 to 2.46) for hypertension; 1.67 (95% CI = 0.85 to 3.31) for CKD; and 1.16 (95% CI = 0.56 to 2.37) for ESRF.
CONCLUSIONS: The prevalence of renal scarring in an unselected population of children with UTI is low. Without underlying risk factors, UTI is not associated with CKD, hypertension, or ESRF by the age of 10 years. Further research with systematic scanning of children\'s kidneys, including those with less severe UTI and without UTI, is needed to increase the certainty of these results, as most children are not scanned. Longer follow-up is needed to establish if UTI, without additional risk factors, is associated with hypertension, CKD, or ESRF later in life.