Constipation may be associated with pyelonephritis and recurrent UTI in girls

Denmark: A recent study has concluded that in children, primarily girls 4-18 years, Constipation is associated with pyelonephritis and recurrent UTI (urinary tract infection). These children didn't have any history of kidney or urinary tract abnormalities.

These findings are published in Acta Paediatrica.

The researchers recommended that systematic evaluation of bowel and bladder function is essential in children aged >4 years after 1st-time pyelonephritis.

It is already known that in childhood, Acute pyelonephritis is the most common bacterial infection. This condition is potentially severe and leads to renal scarring, kidney function loss and hypertension. There is a scarcity of data on risk factors associated with pyelonephritis and recurrent UTIs in children without kidney or urinary tract abnormalities.

Considering this, a study was conducted to identify,

What are the risk factors associated with pyelonephritis in children without kidney or urinary tract abnormalities?

The lead researcher was Dr Sophie from the Department of Pediatrics and Adolescent Medicine and Centre for Research and Education, Gødstrup Hospital, Herning, Denmark.

The critical points of the study are:

• The retrospective analyses of children's medical records (4–18 years) with a history of 1st-time pyelonephritis were done ( 2016 to 2021).
• Children with abnormal kidney ultrasounds were not included in the study.
• Bladder and bowel function information was extracted with fluid intake habits under demographic data.
• One hundred five patients had first-time pyelonephritis.
• As per Rome IV criteria, 47 % of children were diagnosed with Constipation.
• The mean follow-up period was of 167 days.
• The mean fluid intake was 1169 ml/day, and the mean voiding frequency was six times/day.
• There was a positive association between Constipation and recurrent urinary tract infection with a significant p-value.

The researchers wrote in our study 47% of the enrolled children had Constipation which is considerably higher than the estimated prevalence of Constipation in childhood, constituting 16%.

They added we utilised the systematic follow-up for children with 1st-time pyelonephritis after four years of age for risk factors identified.

We identified children with Constipation in large numbers, so we believe that a systematic follow-up programme is essential for children after their 1st time pyelonephritis so that the risk of UTI is reduced with subsequent renal scarring.

In our study, we observed a high incidence of Daytime Urinary Incontinence and Enuresis Nocturna in our cohort compared to the background population, so it is recommendable to evaluate both bowel and bladder function in all children after 1st-time pyelonephritis.

The researchers acknowledged Marie-Louise E. Andersen, MD, PhD, for helping identify the children for the present study.

Further reading:

Functional Constipation as a risk factor for pyelonephritis and recurrent urinary tract infection in children. Sofie Axelgaard et al.