RENAL FUNCTION TESTS IN NONACUTE RECURRENT URINARY TRACT INFECTIONS IN CHILDREN

The clinical value of various renal function tests in recurrent urinary tract infections in children has been examined. The study also includes an evaluation of glomerular capacity versus tubular capacity in recurrent urinary tract infections. There was no good correlation between blood urea nitrogen concentration and serum creatinine concentration within the normal limits for these two parameters. When blood urea nitrogen concentration and/or serum creatinine concentration were elevated, a highly significant correlation between the two parameters was found. When relating blood urea nitrogen concentration to the clearance of inulin an elevation of blood urea nitrogen concentration was not found until the filtration rate was below 50 ml/min/1.73 m² b.s. The tubular functions were examined by studies of (a) the concentrating capacity, (b) the diluting capacity, (c) sodium reabsorption and id) renal acid-base regulation. The concentrating capacity was determined by two screening tests, maximal urine osmolality after 19 hours of fluid and food deprivation with or without injection of pitressin tannate, and by free water reabsorption. The administration of exogenous pitressin had no significant effect on maximal urine osmolality. There was a highly significant correlation between free water reabsorption and maximal urine osmolality. A highly significant correlation was also found between free water reabsorption and glomerular filtration rate. Diluting capacity was evaluated by determining minimum urine osmolality and free water clearance. A highly significant correlation between minimum urine osmolality and free water clearance was obtained. There was a good correlation between free water clearance and glomerular filtration rate. When sodium reabsorption is depressed below normal, urine sodium concentration during hydropenia is abnormally low. A normal standard bicarbonate level does not exclude a defect in renal acidifying mechanisms. A defect renal acidifying capacity could be found even in patients with normal filtration rates indicating that renal acidifying capacity might be the first sign of renal damage in children with recurrent urinary tract infections.