Pediatric Emergency Department, La Paz University Hospital, Madrid, Spain.
Urology Department, Clínica Universidad de Navarra, Marquesado de Santa Marta, 1, 28027, Madrid, Spain.
Eur J Pediatr. 2023 Nov;182(11):4867-4874. doi: 10.1007/s00431-023-05149-z. Epub 2023 Aug 17.
Urinary tract infections are the initial manifestation in 30% of urinary tract malformations. Identifying these patients, who could benefit from a specific treatment, is still challenging. Hyponatremia during urinary tract infection has been proposed as a urinary tract malformation marker. We evaluate the prevalence of hyponatremia during febrile urinary tract infections and its association with subjacent urinary tract malformations. We performed a retrospective study of healthy patients under 16 years, diagnosed with a first episode of febrile urinary tract infection, who had undergone blood testing in the acute episode and at least one renal ultrasound during follow-up (January 2014-November 2020). Hyponatremia was defined as (serum sodium ≤ 130 mEq/L). According to imaging findings, we classified patients into three groups: normal kidney ultrasound, mild pelviectasis, and significant urinary tract malformation. We performed logistic regression models to identify independent risk factors for urinary tract malformation and mild pelviectasis. We included 492 patients and 2.8% presented hyponatremia. We identified normal ultrasound in 77%, mild pelviectasis in 10.8%, and urinary tract malformation in 12% of patients. We found an association between mild pelviectasis and hyponatremia [OR 6.6 (CI95% 1.6-26.6)]. However, we found no association between hyponatremia and urinary tract malformation. The parameters that were associated with malformations were presenting a non-E. coli infection, C-reactive-protein levels over 80 mg/L, and bacteremia.
Hyponatremia during the first episode of febrile urinary tract infection is present in 2.8% of patients and is associated with mild pelviectasis in imaging. However, hyponatremia does not indicate a greater need for complementary tests to screen for urinary tract malformations.
• Urinary tract infection is the first manifestation in 30% of children with urinary tract malformation. • Hyponatremia could be a marker to identify these children and guide the imaging approach.
• Around 12% of children with a first episode of febrile urinary tract infection have a urinary tract malformation. • Non-E. coli infection, C-reactive protein levels over 80 mg/L, and bacteremia are markers for malformations to guide diagnostic imaging tests, but hyponatremia (Na ≤ 130 mEq/l) is not a reliable marker.
尿路感染是 30%尿路畸形患者的首发表现。识别这些可能受益于特定治疗的患者仍然具有挑战性。尿路感染期间出现低钠血症被提出作为尿路畸形的标志物。我们评估了发热性尿路感染期间低钠血症的发生率及其与潜在尿路畸形的关系。
我们对 16 岁以下的健康患者进行了一项回顾性研究，这些患者首次发作发热性尿路感染，在急性发作时进行了血液检查，并在随访期间（2014 年 1 月至 2020 年 11 月）至少进行了一次肾脏超声检查。低钠血症的定义为（血清钠≤130mEq/L）。根据影像学结果，我们将患者分为三组：正常肾脏超声、轻度肾盂扩张和明显的尿路畸形。我们进行了逻辑回归模型以确定尿路畸形和轻度肾盂扩张的独立危险因素。
我们纳入了 492 名患者，其中 2.8%出现低钠血症。我们发现 77%的患者超声检查正常，10.8%的患者轻度肾盂扩张，12%的患者尿路畸形。我们发现轻度肾盂扩张与低钠血症之间存在关联[OR 6.6（95%CI95%1.6-26.6）]。然而，我们没有发现低钠血症与尿路畸形之间的关联。与畸形相关的参数是存在非大肠杆菌感染、C 反应蛋白水平超过 80mg/L 和菌血症。
发热性尿路感染首次发作时低钠血症的发生率为 2.8%，在影像学上与轻度肾盂扩张相关。然而，低钠血症并不表明需要进行更多的补充检查来筛查尿路畸形。
