What is the prognosis of pediatric urinary tract infection (UTI) and what are the potential complications?

Updated: Mar 19, 2019
  • Author: Donna J Fisher, MD; Chief Editor: Russell W Steele, MD  more...
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Answer

Mortality related to UTI is exceedingly rare in otherwise healthy children in developed countries.

Cystitis may cause voiding symptoms and require antibiotics, but it is not associated with long-term, deleterious kidney damage. The voiding symptoms are usually transient, clearing within 24-48 hours of effective treatment.

Morbidity associated with pyelonephritis is characterized by systemic symptoms, such as fever, abdominal pain, vomiting, and dehydration. Bacteremia and clinical sepsis may occur. [9]

Children with pyelonephritis may develop focal inflammation of the kidney (focal pyelonephritis) or renal abscess. Any inflammation of the renal parenchyma may lead to scar formation. Approximately 10-30% of children with UTI develop some renal scarring; however, the degree of scarring required for the development of long-term sequelae is unknown.

Long-term complications of pyelonephritis are hypertension, impaired renal function, and end-stage renal disease.

Dehydration is the most common acute complication of UTI in the pediatric population. Intravenous fluid replacement is necessary in more severe cases.

In developed countries, kidney damage with long-term complications as a consequence of UTI has become less common than it was in the early 20th century, when pyelonephritis was a frequent cause of hypertension and end-stage renal disease in young women. This change is probably a result of improved overall healthcare and close follow-up of children after an episode of pyelonephritis. Currently, these complications are most commonly encountered in infants with congenital renal damage. [10, 11]


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