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Published on: January 7, 2019
Vesicoureteral reflux: subpopulations of patients defined by clinical variables
M J Gelfand1, B L Koch, G G Cordero
1Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039, USA.
Insights
Urinary tract infection (UTI) imaging in girls should consider age and maximum temperature to predict vesicoureteral reflux (VUR). This approach refines diagnosis beyond uniform evaluations for all children with UTI.
Area of Science:
- Pediatric Nephrology
- Diagnostic Imaging
- Infectious Diseases
Background:
- Current imaging practices for pediatric urinary tract infections (UTIs) are often uniform, overlooking critical differences in pathophysiology among patient subgroups.
- This generalized approach fails to account for varying risks of abnormal findings in different pediatric populations with UTIs.
Purpose of the Study:
- To identify key clinical predictors of vesicoureteral reflux (VUR) in a large cohort of girls diagnosed with their first UTI.
- To evaluate the predictive value of six clinical variables for VUR in girls presenting with UTI.
Main Methods:
- Analysis of data from 919 girls undergoing initial UTI imaging.
- Logistic regression and chi-square tests were employed to analyze the relationship between VUR and clinical variables: age, maximum body temperature (Tmax), UTI history, hospitalization, family history, and antibiotic response.
- Vesicoureteral reflux (VUR) was the primary dependent variable assessed.
Main Results:
- Vesicoureteral reflux (VUR) was identified in 28.8% of the girls studied.
- VUR prevalence varied significantly by age and temperature: 56.1% in infants <6 months with Tmax ≥38.5°C versus 13.0% in girls ≥10 years with Tmax <38.5°C.
- Logistic regression confirmed that only age and maximum body temperature (Tmax) were independent predictors of VUR.
Conclusions:
- Girls with UTIs represent a heterogeneous group, not a single homogeneous entity.
- The likelihood of VUR is significantly influenced by maximum body temperature (Tmax) and inversely related to the patient's age.
- Clinical data on age and Tmax should guide decisions regarding the necessity of cystography for girls with UTIs.
Background:
The first imaging evaluation of the child with urinary tract infection (UTI) is often the same for all children, regardless of the child's clinical presentation. However, this approach is simplistic and ignores considerable differences in the frequency of abnormal pathophysiology in different subpopulations of children with UTI.
Objective:
Six clinical variables are evaluated as predictors of vesicoureteral reflux (VUR) in a large series of girls with UTI.
Materials And Methods:
Data were collected from a consecutive series of 919 girls undergoing a first imaging evaluation for UTI. Six input variables were used: age, maximum body temperature (T(max)), number of UTIs, hospitalization, family history of childhood UTI, and rapidity of response to antibiotic therapy. The dependent variable was VUR. Data were enumerated and analyzed by logistic regression and the chi-square test.
Results:
VUR was present in 28.8 %. The percentage with VUR varied from 56.1 % for age < 6 months and T(max) L 38.5 degrees C to 13.0 % for age L 10 years and T(max) < 38.5 degrees C. The frequency of VUR was significantly lower in girls with T(max) < 38.5 degrees C in most age groups. Logistic regression demonstrated, when all clinical variables were taken together, that only age and T(max) were independent predictors of VUR.
Conclusions:
Girls with UTI should not be considered to be a homogeneous group. The frequency of VUR is related to T(max) and inversely to age. Data about these subpopulations should be used in deciding which girls should undergo cystography.
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