Although long postulated, the link between recurrent urinary tract infections during childhood and chronic kidney disease later in life has little support, according to a study led by Dr. Jarmo Salo.
As many as 5% of children experience one or more urinary tract infections (UTIs) before puberty, making it one of the most common bacterial infections during childhood.
A systematic literature review of articles published between January 1966 and August 2009 to explore the connection between UTIs and chronic kidney disease (CKD) yielded 781 articles; Dr. Salo and his team further narrowed their search to 39 articles and ultimately included 10 articles in their analysis. None of the studies was designed to determine the etiology of CKD. The researchers found that of the 1,576 subjects included in these studies, only 3 (0.2%) cases of CKD could be attributed to a childhood UTI. However, it was not possible to tell definitively if any of those three cases of CKD were caused by UTIs because the structures of the patients’ kidneys were not evaluated or reported prior to development of the recurrent UTIs (Pediatrics 2011 Oct. 10 [doi:10.1542/peds.2010-3520]).
In addition, the researchers monitored 366 patients at the University of Oulu (Finland). Through evaluating patient records and interviews, the researchers found that of the 366 children, only 13 patients with CKD had no specific noninfectious cause, such as glomerulonephritis or diabetic nephropathy, but did have a history of childhood UTIs.
Of the 13, 6 exhibited urethral obstructions or congenital anomalies that can cause kidney failure on their own. Four others demonstrated dysplastic or hypoplastic kidneys in their first kidney imaging studies and experienced only one or two UTIs in childhood. The remaining three cases of CKD may have had childhood UTIs as a major contributing factor to the development of CKD. This means that, at most, only 0.3% of CKD cases were caused by childhood UTIs.
Because the risk of developing CKD after the first UTI is small, Dr. Salo and associates recommend focusing imaging procedures on finding severe urinary tract abnormalities.
The Juho Vainio Foundation, the Päivikki and Sakari Sohlberg Foundation, and the Paulo Foundation provided financial support for the study. Dr. Salo and associates did not report any relevant financial disclosures.