Gkrepi Aikaterini, Serbis Anastasios, Giapros Vasileios, Kosmeri Chrysoula, Tsiouris Spyridon, Xydis Vasileios, Ladomenou Fani, Dermitzaki Niki, Makis Alexandros, Siomou Ekaterini
Departments of Pediatrics, University Hospital of Ioannina, Ioannina, Greece.
Departments of Neonatal Intensive Care Unit, University Hospital of Ioannina, Ioannina, Greece.
J Pediatr Urol. 2025 Jun 17. doi: 10.1016/j.jpurol.2025.06.012.
The aim of this study was to evaluate possible predictive factors for acute pyelonephritis (APN) and renal scarring in children ≤2 years of age hospitalized with a first febrile urinary tract infection (UTI).
Sixty patients and 63 age-matched controls were prospectively included in the study. On admission, work-up including cystatin C, vitamin 25OHD, and urine angiotensinogen (U-AGT) was conducted. Children with UTI had an acute DMSA scan (technetium 99m-dimercaptosuccinic acid scan) and were grouped in those with a normal DMSA and those with APN findings on DMSA scanning. The patients with APN had a follow-up DMSA scan after 6 months to evaluate for renal scarring.
The children with APN (53 %) had significantly higher CRP and ESR and lower 25OHD levels compared with normal DMSA group. The correlation between 25OHD level and APN remained significant after adjusting for age, fever duration and CRP/ESR level. Cystatin C and U-AGT levels did not differ significantly between patients and controls. Renal scaring was found in 33 % of children with APN. CRP levels >100 mg/L during APN and vesicoureteral reflux (VUR) grade ≥3 were found more frequently in children with renal scarring, comparing to those without scarring (p < 0.01).
Vitamin D levels could be an independent predictor of acute renal damage in children with febrile UTI. Cystatin C and U-AGT were not found to be predictive factors for renal damage. CRP levels >100 mg/L during APN and VUR grade ≥3 were associated with renal scarring.
本研究旨在评估2岁及以下因首次发热性尿路感染（UTI）住院的儿童发生急性肾盂肾炎（APN）和肾瘢痕形成的可能预测因素。
前瞻性纳入60例患者和63例年龄匹配的对照。入院时进行了包括胱抑素C、维生素25OHD和尿血管紧张素原（U-AGT）在内的检查。患有UTI的儿童进行了急性二巯基丁二酸肾动态显像（99m锝-二巯基丁二酸扫描），并根据二巯基丁二酸肾动态显像结果分为正常组和APN组。APN患者在6个月后进行随访二巯基丁二酸肾动态显像以评估肾瘢痕形成情况。
与二巯基丁二酸肾动态显像正常组相比，APN患儿（53%）的CRP和ESR显著更高，25OHD水平更低。在调整年龄、发热持续时间和CRP/ESR水平后，25OHD水平与APN之间的相关性仍然显著。患者和对照组之间的胱抑素C和U-AGT水平无显著差异。33%的APN患儿发现有肾瘢痕形成。与无瘢痕形成的儿童相比，APN期间CRP水平>100mg/L和膀胱输尿管反流（VUR）≥3级在有肾瘢痕形成的儿童中更常见（p<0.01）。
维生素D水平可能是发热性UTI儿童急性肾损伤的独立预测因素。未发现胱抑素C和U-AGT是肾损伤的预测因素。APN期间CRP水平>100mg/L和VUR≥3级与肾瘢痕形成有关。
