Careful Urinary Tract Infection Evaluation (CUTIE)

General Description

Urinary tract infections (UTIs) are the most common serious bacterial infections in young children. When accompanied by a fever, there is an increased likelihood of a UTI also infecting the kidneys; between 15 and 52% of these children will develop kidney scarring as a result.

The Careful Urinary Tract Infection Evaluation (CUTIE) study was an observational study designed to determine why some children develop kidney scars after urinary tract infections (UTIs). The study was aimed at understanding which children were at the greatest risk of developing renal scarring following a UTI, so physicians can provide targeted therapies and appropriate interventions. Children between 2 months and 6 years of age who had a first or second UTI in the past 4 months were eligible for enrollment in the study. Participants were followed for 2 years through the course of five study visits, during which they were required to undergo a physical exam and provide information about recent medical history and quality of life via a questionnaire completed by parents. Additionally, blood and urine biospecimens were collected to monitor kidney function, and renal scans were performed to assess the development of kidney damage.

The CUTIE study was ancillary to the RIVUR (Randomized Intervention for Children with Vesicoureteral Reflux) study, which compared antibiotic prophylaxis to placebo in a cohort of children with a history of UTI and vesicoureteral reflux. The CUTIE study focused specifically on children with a history of UTI who did not have vesicoureteral reflux. More information about the RIVUR study is available on the NIDDK repository website.

Objectives

The primary aim of the study was to determine the risk factors for developing renal scarring in children as a result of a UTI.

Outcome Measure

Medical history, quality of life, kidney function, and development of kidney damage were measured to the determine risk factors for renal scarring.

Criteria

Children between 2 months and 6 years of age were eligible for the study if they meet the following criteria:

• Has had no more than 2 UTIs with either fever or symptoms
• Was treated for the first UTI for at least seven days with an effective antibiotic
• No history of VUR
• No history of other renal injury or serious disease
• No allergies to sulfa medications

Outcome

VUR and BBD were risk factors for recurrent UTI, especially when they appeared in combination. Strategies for preventing recurrent UTI include antimicrobial prophylaxis and treatment of BBD.