ASN: Recurrent UTIs Impact eGFR in Children With Vesicoureteral Reflux

MONDAY, Oct. 28, 2024 (HealthDay News) -- For children with vesicoureteral reflux, recurrent urinary tract infections (UTIs) are associated with a decrease in estimated glomerular filtration rate (eGFR), according to a research letter published online Oct. 24 in JAMA Pediatrics to coincide with Kidney Week, the annual meeting of the American Society of Nephrology, held from Oct. 23 to 27 in San Diego.

David S. Hains, M.D., from Indiana University School of Medicine in Indianapolis, and colleagues examined eGFR changes at the individual level in participants with and without UTI from the Randomized Intervention for Children With Vesicoureteral Reflux trial, which assessed antibiotic prophylaxis and recurrent UTIs. Data were included for 188 participants with entry and exit eGFR.

The researchers found that the mean change in eGFR was 9.5 mL/min/1.73 m². Compared with those with no more than one UTI, children with more than one study UTI had a mean eGFR change 12.3 mL/min/1.73 m² lower (−1.9 versus 10.4 mL/min/1.73 m²). Compared with those with no more than one UTI, children with more than one study UTI receiving placebo had a mean eGFR change 19.9 mL/min/1.73 m² lower (−5.9 versus 13.9 mL/min/1.73 m²). Compared with those with no more than one febrile UTI, children with more than one febrile UTI receiving placebo had a 27.1 mL/min/1.73 m² lower net change in eGFR. Those treated with prophylactic antibiotics exhibited no significant difference.

"Multiple UTIs may have detrimental effects in kidney function, presumably as acute kidney injury events. Antibiotic prophylaxis, even if discordant, may limit breakthrough UTI severity or subsequent AKI and subsequently preserve eGFR," the authors write. "UTIs resulting in a negative eGFR change may have long-lasting consequences. This report indicates that recurrent UTIs were associated with a decrease in eGFR of up to 27 mL/min/1.73 m²."

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