Long-term consequences of urinary tract infection in childhood: an electronic population-based cohort study in Welsh primary and secondary care

Journal article

BackgroundChildhood 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.AimTo examine the association between childhood UTI and outcomes in an unselected population of children.Design and settingA retrospective population-based cohort study using linked GP, hospital, and microbiology records in Wales, UK.MethodParticipants 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.ResultsIn 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.ConclusionThe 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.

Authors: Hughes, K; Cannings-John, R; Jones, H; Lugg-Widger, F; Lau, TMM

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Royal College of General Practitioners
• Journal: British Journal of General Practice
• Volume: 74
• Issue: 743
• Pages: e371-e378
• Publication date: 2024-05-30
• DOI: 10.3399/bjgp.2023.0174
• EISSN: 1478-5242
• ISSN: 0960-1643
• Pmid: 38806210
• Language: English
• Keywords: Humans; Urinary tract infections; Retrospective Studies; Female; Male; Child, Preschool; Risk Factors; Cicatrix; Renal Scarring; Renal Insufficiency, Chronic; Wales; Hypertension; Infant; Kidney failure, chronic; Urinary Tract Infections; Secondary Care; Primary Health Care; Kidney Failure, Chronic; Child