FEATURES

Answers to Burning Questions About Pediatric Urinary Tract Infections

January 29, 2020
Written by

Nationwide Children’s urologists and nephrologists recently co-hosted a Twitter chat for primary care providers, answering common questions about pediatric urinary tract infections (UTIs). Below is a summary of the questions and answers, adapted for brevity and clarity.

Q: What causes UTIs in children?

A: UTIs are typically caused by uropathogenic E. coli bacteria that invade the urinary tract from the gastrointestinal tract. However, in immunocompromised patients, they can be caused by a virus, such as adenovirus and polyomavirus (BK virus).

Q: What are the symptoms of UTIs in children? Are they different from adult symptoms?

A: Symptoms of UTI are often related to irritation of the urinary tract, such as painful urination, blood in the urine, new or worsening incontinence, abdominal or flank pain, and fever. While symptoms in children and adults can be similar, young children may not be able to verbalize pain in the same way as older patients. In those cases, symptoms may be more nonspecific – such as fever, irritability and lethargy.

Q: Is susceptibility to UTI inherited? Do UTIs run in families?

A: Some studies have shown that genetic variations in host defense genes increase UTI susceptibility. These genes can run in families. Right now, researchers are just beginning to uncover the role of genetics in UTI. There’s much more work to be done.

Q: What are the risk factors for recurrent UTIs?

A: Many of the risk factors for an initial UTI are the same for recurrent UTIs. General risk factors include: vesicouretal reflux (VUR), bowel and bladder dysfunction, age, anatomic abnormalities, genetics, antibiotic resistance and existing UTI. 

UTIs can be labeled “recurrent” when there is bacterial persistence (failure to fully treat/clear the initial UTI) or if new bacteria have infected the tract. Some studies suggest that immune system over-reactivity can predispose people to recurrent UTIs.

Q: When should children take a daily antibiotic to prevent recurrent UTIs? What are alternative treatment options that reduce antibiotic use?

A: Providers should try to minimize antibiotic use as much as possible and use a personalized medicine approach. However, this can be a complicated topic depending on the case. Strong evidence exists that antibiotic prophylaxis can decrease the frequency of UTIs in children with vesicoureteral reflux, but that must be balanced with concerns about promoting resistance in bacteria.

Cranberries have an active ingredient that prevents bacterial attachment in the bladder.  However, it can be difficult to obtain enough of this particular ingredient in regular juice to know if drinking cranberry juice alone will help prevent UTI.  There is also a naturally occurring sugar called D-mannose that can prevent bacterial attachment. This is not used routinely, however, to fight UTI at this time.  There’s also interest in the possible manipulation of the microbiome to alter UTI risk, but more research is needed. Several researchers at Nationwide Children’s are also investigating boosting innate immunity responses, particularly through antimicrobial peptides (AMPs).

Q: Do UTIs lead to kidney damage?

A: UTIs cause renal damage through tubular interstitial nephritis and resulting renal scarring. UTIs can ascend into the kidney and attach to the intercalated cells. The resulting immune response can cause tubulointerstitial nephritis and kidney damage.

Q: What research is most important to improve UTI understanding and outcomes?

A: Suggestions for future research include:

  • How to achieve a balance between a beneficial immune response to eradicating infection and avoiding kidney and bladder injury
  • Understanding the difference between host and uropathogenic coli responses
  • New diagnostics
  • Understanding of the microbiome’s role
  • Preventative strategies beyond antibiotics

 

Answers were provided by:

Nationwide Children’s physicians and researchers regularly host peer-to-peer chats through @NCHforDocs. Search #PedsMedChat for past conversations, including ones on interventional radiology, social media in health care and how to have “The Talk” with kids.