Denmark: Study on Constipation and Pyelonephritis in Children

A recent study has concluded that in children, primarily girls aged 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 over 4 years after first-time pyelonephritis.

Background

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.

Study Objective

Considering this, a study was conducted to identify 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.

Key Findings

• The retrospective analyses of children's medical records (4–18 years) with a history of first-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 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.

Conclusions

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 first-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 first-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 first-time pyelonephritis.

Acknowledgments

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.