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Infants Kidney Infection First Developed by Symptoms of UTI

Urinary tract infections are quite common in infancy and childhood, including the neonatal period. They vary greatly in their clinical manifestations and range from comparatively mild asymptomatic lower tract infections, to life threatening infections of the renal parenchyma. In our experience, the incidence in hospitalized children may be as high as 8%. Urinary tract infection may mimic many diseases such as gastroenteritis, pyrexia of unknown origin and failure to thrive.

Predisposing Factors:

Male infants are more commonly affected, due to a higher incidence of structural anomalies of the urinary tract. After early childhood, UTI's are overwhelmingly more common in girls, their short urethra providing an easy portal of entry for bacteria.
Ureterovesical reflux plays an important role in the causation of urinary tract infection.
Obstructive uropathy predisposes to urinary tract infection both by inhibiting the elimination of bacteria and by distorting the architecture of the proximal urinary tract.

Etiological Agents in UTI:

Among the causative bacteria, E. coli is the commonest. Klebsiella, the Enterobacter group, Staphylococcus, Proteus, Pseudomonas, and non-haemolytic Streptococci may cause UTI. Infection by Salmonella is rare.
Clinical Features

The onset may be either acute or insidious. In symptomatic cases there is fever, pallor, toxemia, anorexia, and vomiting. The temperature may be high and accompanied by chills, urinary frequency, painful micturition and loin pain. A bowel upset, constipation or diarrhea commonly precedes the acute symptoms. In the young infant meningism or convulsions are common. In less acute cases persistent vomiting and failure to thrive are common manifestations.

In infants with urinary tract infections, early antibiotic treatment reduces the risk of kidney involvement, but does not prevent scarring if a kidney infection develops, according to study findings published in the current issue of Pediatrics.

Kidney scarring is a serious condition in infants and children, causing and include rains effects such as a higher risk of kidney stones, reduction in kidney size; decline in organ function and high blood pressure.

Delaying treatment has been singled out as the most important factor that is likely to effect the development of scarring after acute kidney infection, Dr. Dimitrios Doganis and colleagues from "P & A Kyriakou" Children's Hospital, Athens, note. However, no studies have been conducted that support this.

In a 5-year study, the researchers looked at the time between the start of kidney infection and therapy, and the development of tissue changes caused by inflammation that leads to scaring. The study included 278 infants, between the ages of 0.5 and 12 months, who developed their first urinary tract infection.

Kidney imaging tests were performed within 1 to 18 days of hospital admission and a second scan was performed in infants with tissue abnormalities after 5 to 26 months.

The average time between the onset of infection and the start of treatment was 2 days. Of the 278 children, 158 (57 percent) had initial inflammatory changes in the kidney.

Fifty-one percent of infants with an abnormal scan in early stages of infection developed kidney scarring, according to the authors, but there was no statistically significant difference in the frequency of scarring in infants treated early compared with those treated later.

This suggests that once a kidney infection begins, the scarring that develops is independent of the timing of therapy, Doganis and colleagues surmise.

Early and appropriate treatment of urinary tract infection, especially during the first 24 hours after the onset of symptoms, reduces the likelihood of kidney involvement during the initial phase of infection, but can't prevent scarring, the researchers conclude.

In older children frequency and dysuria make the diagnosis easier although their absence does not exclude UTI. In untreated cases of acute pyelonephritis the high fever usually subsides spontaneously after 7-10 days but the child remains apathetic, anorexic and fails to gain weight.

Thus it should be remembered that UTI of childhood is a great mimicker. Routine examination of the urine should be part of any pediatric consultation.

All cases of recurrent UTI should be investigated properly for evidence of structural anomalies in the renal tract. Occasionally recurrent UTI occur in children particularly in girls, in whom no structural anomaly of kidney and urinary tract can he demonstrated. Recurrent urinary tract infection warrants long term chemoprophylaxis.

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