Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Futian District, Shenzhen, Guangdong, China.
Department of Infectious Diseases, Department of Urology and Laboratory of Pelvic Floor Muscle Function, and Department of Clinical Laboratory, Shenzhen Children's Hospital, Shenzhen, China.
Eur J Pediatr Surg. 2023 Dec;33(6):499-502. doi: 10.1055/s-0043-1760823. Epub 2023 Jan 31.
Our objective was to evaluate whether renal function, assessed as the estimated glomerular filtration rate (eGFR), is associated with the number of febrile urinary tract infections (FUTIs) in children diagnosed with neurogenic bladder (NB).
Clinical information of patients diagnosed with NB was prospectively collected between January 2013 and January 2022. Episodes of FUTI were recorded during the follow-up period, and the eGFR was calculated based on the serum cystatin C level. Grading (G1-G5) of chronic kidney disease (CKD) was conducted as described by the eGFR.
In total, 463 children were included in the final analysis (265 males and 198 females; mean age: 23 months). The median follow-up time was 51 months. A total of 302 children had four or more FUTIs and 161 children had none to three FUTIs. The incidence of developing CKD G3 to G5 gradually increased from the first to third (1.3-2.4%) episodes of FUTI and drastically increased after four episodes (≥ 22.5%), with the incidence recorded to be 100% after eight FUTIs. The odds of CKD G3 to G5 in children with four FUTIs were 17.3 and 43.7 times greater after four and six FUTIs, respectively, than in children with one FUTI.
This study showed that recurrent FUTIs are common in children with NB and that the risk of rapid progression to CKD G3 to G5 increases substantially after four or more FUTIs episodes.
本研究旨在评估肾小球滤过率（eGFR）作为肾功能评估指标，与诊断为神经源性膀胱（NB）的儿童发热性尿路感染（FUTI）次数之间的关系。
前瞻性收集 2013 年 1 月至 2022 年 1 月间诊断为 NB 的患者的临床资料。随访期间记录 FUTI 发作次数，并基于血清胱抑素 C 水平计算 eGFR。根据 eGFR 将慢性肾脏病（CKD）分级（G1-G5）。
共纳入 463 例最终分析的患儿（男 265 例，女 198 例；平均年龄 23 个月）。中位随访时间为 51 个月。302 例患儿发生 4 次或以上 FUTI，161 例患儿发生 1 至 3 次 FUTI。发生 CKD G3 至 G5 的比例自首次至第三次 FUTI 逐渐升高（1.3%-2.4%），第四次 FUTI 后急剧增加（≥22.5%），第八次 FUTI 后发病率达 100%。发生 4 次 FUTI 的患儿发生 CKD G3 至 G5 的几率是发生 1 次 FUTI 的患儿的 17.3 倍和 43.7 倍，发生 6 次 FUTI 的患儿是发生 1 次 FUTI 的患儿的 305.4 倍。
本研究表明，NB 患儿常发生复发性 FUTI，且发生 4 次或以上 FUTI 后，CKD G3 至 G5 进展风险显著增加。
