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Vesicoureteric reflux in Kuwaiti children with first febrile urinary tract infection
Mohamed Zaki1, Ghalia Al Mutari, Mona Badawi
1Department of Pediatrics, Farwania Hospital, Kuwait. redc66@yahoo.com
Insights
Vesicoureteric reflux (VUR) occurs in 22% of Arab Kuwaiti children with febrile urinary tract infections (UTIs). Females showed higher rates of VUR and abnormal renal scans compared to males.
Area of Science:
- Pediatrics
- Nephrology
- Urology
Background:
- Vesicoureteric reflux (VUR) is a condition where urine flows backward from the bladder to the ureters or kidneys.
- The prevalence of VUR in children with urinary tract infections (UTIs) varies significantly across different racial and ethnic groups.
- Understanding these variations is crucial for accurate diagnosis and management of pediatric UTIs and associated renal damage.
Purpose of the Study:
- To determine the frequency of VUR in Arab Kuwaiti children experiencing their first febrile UTI.
- To identify associated renal changes, such as acute pyelonephritis or renal scars, using DMSA scans.
- To compare the findings with prevalence rates reported in other racial groups globally.
Main Methods:
- A cohort of 174 Arab Kuwaiti children (38 males, 136 females) with their first documented febrile UTI were included.
- All patients underwent micturating cystourethrography (MCUG) to detect VUR and 99m-Tc-dimercaptosuccinic acid (DMSA) renal scans to assess for renal damage.
- Children were categorized into three age groups: <1 year, 1-5 years, and >5 years.
Main Results:
- Vesicoureteric reflux (VUR) was detected in 22% (39 out of 174) of the children studied.
- Females exhibited a higher prevalence of VUR (24%) compared to males (18%).
- Abnormal DMSA scans, indicating acute pyelonephritis or renal scars, were found in 36% of patients, with a significantly higher rate in females (43%) than males (11%).
- Children under 5 years old accounted for 79% of those with abnormal DMSA scans.
- The combination of abnormal DMSA scans and VUR was more common in females (14%) than males (3%).
Conclusions:
- The frequency of VUR in Arab Kuwaiti children with febrile UTI falls between rates reported for Caucasian and other racial groups.
- Females represent a higher-risk group for both VUR and renal damage following UTI, irrespective of VUR presence.
- Early diagnosis and management of UTIs in children, particularly females, are essential to prevent long-term renal sequelae.
Abstract:
The prevalence of vesicoureteric reflux (VUR) in children with urinary tract infection (UTI) varies among different racial groups. The purpose of this study was to determine the frequency of VUR and associated renal changes in a group of Arab Kuwaiti children with their first documented febrile UTI and to compare our findings with those reported from other racial groups. One hundred and seventy-four children (38 males and 136 females) fulfilled the study criteria and were divided into three age groups (<1 year, 1-5 years, and >5 years). Patients in each group had both micturating cystourethrography (MCUG) and 99m-Tc-dimercaptosuccinic acid (DMSA) renal scan after diagnosis. VUR was detected in 39 children (22%). Two-thirds of cases had mild reflux (grade I and II). Females ( n=32) had more reflux than males ( n=7) (24% vs. 18%). Sixty-three patients (36%) had abnormal (DMSA) renal scans (acute pyelonephritis [AP] or renal scars). Of these, 79% were children below 5 years. Abnormal DMSA scans were found in 4 of 38 males (11%) versus 59 of 136 females (43%). Abnormal scans in children with VUR were seen in 1 of 7 males (14%) versus 19 of 32 females (59%). In total, the combination of abnormal scan with VUR occurred in 1 of 38 males (3%) and in 19 of 136 females (14%), whereas abnormal scan without demonstrable VUR was seen in 3 of 38 males (8%) versus 40 of 136 females (29%). Our data showed that the frequency of VUR in Arab Kuwaiti children with febrile UTI is midway between Caucasian and other racial groups. In this study, males had a lower-risk profile than females, the latter having a higher rate of reflux as well as a higher rate of abnormal DMSA scans, irrespective of demonstrable VUR.
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