Urinary system abnormalities in children with urinary tract infection

Urinary tract infections are important causes of diseases in childhood. They are second most common infectious diseases and genitourinary diseases in children. Their incidences have been reported as 3-28/1000 for female and 1.5-7/1000 for male. urinary tract infections may be seen associated with anatomic malformations of urinary system. Experiencing upper urinary system infections is a significant risk factor for development of renal scar formation, renal failure and hypertension. In recent 30-40 years pathogenesis and natural course of childhood urinary tract infections and predisposing factors for parenchymal damage have been well understood, and in order to decrease acute morbidity and long term sequelaes, most suitable and detailed investigations are required. Especially recurrent urinary tract infections and underlying anatomic disorders including vesicouretheric reflux and obstruction are significant in terms of serious complications. In our country chronic kidney failure related to urinary tract infections is still very important. So by early diagnosis and treatment of patients renal damage may be prevented or decreased. In this study urinary tract infections identified in 120 patients applied to Pediatric Nephrology Clinic of Dicle University Medical School between 2010-2014 years were retrospectively investigated. In present study risks, etiology, clinical findings, factors, accompanying patologies and imaging technics of urinary tract infections were investigated. 77.5% of patients were male and 22.5% of patients were female. The mean age for female patients was 9.5±3.75 and for male this was 7.12±5.24 years. In anamnesis of these patients urinary tract infection was determined in 16.7% of mother and siblings. The most common urinary tract infection experiencing ages were between 1-5 years with the percentage of 46.7%. Follow up duration of patients was frequently between 1-3 years with the frequency of 43.3%. Number of febrile urinary tract infections between 1-5 times was the most frequent and was found in 72.4% of patients. Culture positive urinary tract infection attack number between 5-10 times and was seen with the percentage of 93.4%. Pyelonephritis attacks number between 1-5 times was with the percentage of 55.8%. E.Coli was identified as the most frequent organism with the percentage of 69.8% E.Coli in ürine cultures. The most frequent ultrasonography finding was pelvic ectasy with the percentage of 37.2% at right side and 28.9% at left side. As being determined the most frequent finding, hypoactive areas in DMSA were reported in right side of 7 patients with the percentage of 5.7% and in 13 patients with the percentage of 10.7%. Patients had Grade IV vesicouretheric reflux most frequently and this was determined in right side for 7 parients (5.8%) and in left side for 4 patients (3.3%). The glomerular filtration rate of patients for right side was calculated as 34.23%, for left side 44.47% and for total 78.73%. Most frequently used antibiotics, trimetohprim+sulfometoxazol, was used by 61 patients (49.5%). Between 6-9 months trimetohprim+sulfometoxazol was the most used antibiotic with the percentage of 19.4%. The most frequent voiding dysfunction findings were squatting down and urinary retention, determined at an average of 49.2%. As an additional diagnosis to urinary tract infection vesicouretheric reflux (VUR) was determined most frequently with the percentage of 27.5%, and neurogenic urinary bladder and voiding disfunction were identified with the percentage of 5.8%. In conclusion, because of developing renal scar in increasing proportionts, in children with recurrent urinary tract infection, effective treatment and regular follow up in early periods are very important for decreasing long term complications. Key Words: Urinary tract infection, Urinary system abnormalities in child, Ultrasonography (USG), Voiding cystourethrography (VCUG), vesicouretheric reflux (VUR).