LUCI

The long-term follow-up of urinary tract infection (UTI) in childhood.

The aim of this project is to determine the short, medium and longer-term outcomes of urine infections (UTI) in childhood and to determine whether there is a difference between UTI that is identified through routine practice and UTI identified through systematic urine sampling (where all ill children have their urine sampled).

Current guidelines advise the prompt diagnosis and treatment of UTI in children because childhood UTI can lead to scarring of the kidneys which is believed to lead to long term complications such as high blood pressure, chronic kidney disease and kidney failure in some cases. However, UTI is difficult to diagnose in children as the symptoms are non-specific and similar to those found in many common childhood illnesses.

The evidence linking childhood UTI with long-term complications is weak and has been questioned. There is an urgent need to clarify the association between childhood UTI, renal scarring and long term complications as the correct approach to urine sampling and diagnosis of UTI in children hinges on this association.

We have previously conducted two large studies of acutely ill children less than five years old in primary care (EURICA study n=1003 Wales only; DUTY study n=7163 England and Wales) and collected urine samples systematically from all ill children. We found UTI was present in 5.9% and 5.6% respectively in NHS laboratories in the two studies. We followed up EURICA children for six months and a sample of DUTY children for three months.

This study will use routinely collected data to follow DUTY and EURICA children up for 5 years to determine short (up to 1 year) and medium (1-5 years) term outcomes for UTI identified through systematic urine sampling. The outcomes of interest will include further UTI episodes, difficulties with passing urine (dysfunctional voiding syndromes), hospital admissions, any scans on the kidneys or bladder, kidney scarring, high blood pressure and kidney failure.