Predictive Factors of Chronic Kidney Disease Risk in Childhood Urinary Tract Infection

This narrative review presents a conceptual framework exploring the relationship between urinary tract infections (UTIs) in children and the risk of chronic kidney disease (CKD) later in life. It highlights predictors of CKD risk and critically examines the evidence for the pathophysiologic pathways linking UTI with CKD. The clinical implications for preventive nephrology are also discussed. The conceptual model for predicting CKD risk from previous episodes of childhood UTI is based on several pathophysiologic pathways. Although the pathophysiologic pathways may include UTI-associated kidney scars and co-existing risk factors for recurrent UTIs like dysfunctional elimination syndrome, high-grade vesicoureteral reflux (VUR), and congenital anomalies of the kidneys and urinary tract (CAKUT), the VUR-UTI-kidney scar-CKD trajectory is currently debatable. Recent evidence-based data suggest that the occurrence of new kidney scars is associated with the presence or absence of UTIs in infants with high-grade VUR, thus challenging the traditional VUR-UTI-kidney scar-CKD paradigm. Most episodes of UTIs do not lead to future CKD if infections are promptly treated and underlying VUR and CAKUT are appropriately managed. Some indirect and direct predictors of CKD risk include demographic factors like young age of incident UTIs and female sex, duration or presence of high-grade VUR, severity of kidney scarring,andmicroalbuminuria. Some of the modifiable predictors that potentially accelerate CKD progression should be targeted by kidney-protective strategies, such as managing VUR, screening for functional risk factors for CKD, or risk markers (e.g., microalbuminuria), and applying pharmacologic or surgical interventions to mitigate these risk factors.

Cite this article as: Uwaezuoke SN. Predictive factors of chronic kidney disease risk in childhood urinary tract infection. Turk J Nephrol. Published online May 22, 2025. doi:10.5152/turkjnephrol.2025.251148.