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Predictive value of clinical and laboratory variables for vesicoureteral reflux in children

Alper Soylu1, Belde Kasap, Korcan Demir

  • 1Department of Pediatrics, Division of Nephrology, Dokuz Eylul University, Medical Faculty, Balcova, 35340, Izmir, Turkey. alper.soylu@deu.edu.tr

Pediatric Nephrology (Berlin, Germany)
|February 3, 2007
PubMed

Insights

Fever and elevated C-reactive protein (CRP) levels can predict vesicoureteral reflux (VUR) in children with urinary tract infections (UTI). High fever and CRP above 50 mg/L are particularly useful for identifying high-grade VUR, potentially reducing unnecessary tests.

Area of Science:

  • Pediatrics
  • Nephrology
  • Infectious Diseases

Background:

  • Urinary tract infections (UTIs) are common in children.
  • Vesicoureteral reflux (VUR) is a significant risk factor for recurrent UTIs and renal scarring.
  • Voiding cystourethrography (VCUG) is the gold standard for VUR diagnosis but is invasive.

Purpose of the Study:

  • To identify clinical and laboratory predictors of VUR in children with febrile UTI.
  • To determine if specific variables can predict high-grade VUR (grades III-V).
  • To assess the potential of these predictors in reducing the need for VCUG.

Main Methods:

  • Retrospective evaluation of 88 children with febrile UTI who underwent VCUG.
  • Analysis of clinical (age, gender, fever, recurrent UTI), laboratory (leukocytosis, ESR, CRP, pyuria, S(Cr)), and imaging (renal ultrasonography) variables.
  • Comparison of children with and without VUR, and with high-grade versus low-grade VUR.

Main Results:

  • Fever ≥ 38.5°C was associated with VUR (OR: 7.5).
  • A CRP level of 50 mg/L was the optimal cutoff for predicting high-grade VUR (OR: 15.5; discriminative ability 0.89).
  • Using CRP > 50 mg/L to guide VCUG could spare 69% of children with no/low-grade VUR while missing only 9% with high-grade VUR.

Conclusions:

  • Fever ≥ 38.5°C may predict VUR in pediatric UTI.
  • CRP > 50 mg/L appears to be a useful predictor of high-grade VUR.
  • These findings could help limit unnecessary VCUG in children with UTI.

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