Urinary tract infections in children and the risk of ESRF

Aims: Paediatric guidance on diagnosis and treatment of urinary tract infections (UTIs) has in the past largely focused on identifying children with vesicoureteral reflux, thought to be at greatest risk of renal scarring. This practice has been questioned, specifically the accepted association between UTI and end-stage renal failure (ESRF) through renal scarring. The aim of this article is to ascertain whether we can predict with confidence the true level of risk that a child with a first-time UTI will subsequently develop ESRF attributable to UTI. Methods: Using data available from renal registries, an analytical approach based on previous estimates of risk is used to demonstrate the range of plausible estimates of risk that can be generated and levels of uncertainty that surrounds those estimates. Results: Estimates of the perceived risk of developing ESRF following UTI range from 1/154 to 1/199 900 and are heavily dependent on the assumptions made and the source of data. Conclusion: There is considerable uncertainty in the relationship between childhood UTI and risk of ESRF based on the data currently available. Until further evidence is available, clinicians will continue to debate the risk of UTI and ESRF and consensus opinion will continue to guide management.