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Vesico ureteric reflux and renal scarring in children with urinary tract infection
I Hazza1, A Wahadeneh, E Qudah
1Department of Pediatrics, King Hussein Medical Center, Amman, Jordan.
Insights
Vesicoureteric reflux (VUR) is common in children with urinary tract infections (UTIs). Renal scarring is more frequent in older children with VUR, highlighting the need for prompt diagnosis and management.
Area of Science:
- Pediatric Nephrology
- Urology
- Diagnostic Imaging
Background:
- Urinary tract infections (UTIs) are common in children.
- Vesicoureteric reflux (VUR) is a significant risk factor for renal scarring.
- Early detection and management are crucial to prevent long-term renal damage.
Purpose of the Study:
- To assess the prevalence of VUR and renal scarring in children with symptomatic UTIs.
- To investigate the impact of age at presentation on VUR and renal scarring.
- To correlate VUR grading with the presence and severity of renal scarring.
Main Methods:
- Retrospective study of 29 pediatric patients with documented symptomatic UTIs.
- Renal ultrasound and dimercaptosuccinic acid (DMSA) scintigraphy performed on all patients.
- Micturating cystourethrogram (MCU) performed based on age and DMSA findings.
Main Results:
- 10 out of 29 (34%) patients with UTI had VUR.
- VUR was more prevalent in children under five years old (7/10).
- Renal scarring was present in 3/7 VUR patients under five, but in all (3/3) VUR patients over five. All patients with Grade 3-4 VUR had scarring; half with Grade 1-2 had scarring.
Conclusions:
- VUR is a common finding in children presenting with UTIs.
- Age is a critical factor, with older children with VUR showing a higher incidence of renal scarring.
- Findings underscore the importance of further investigation and follow-up for VUR in pediatric UTI cases.
Abstract:
To evaluate the presence of vesico ureteric reflux (VUR) and renal scarring in children with documented symptomatic urinary tract infection (UTI), and the importance of age at time of presentation, we studied 29 patients with UTI. Nineteen patients were females and 10 were males. Three patients were below one year of age, 13 were between one and five years, and 13 were above five years. None of the patients had systemic hypertension or renal insufficiency. All patients had renal ultrasound and renal scintigraphy with dimercapto succinic acid (DMSA). Micturating cystourethrogram was done in all children below age of five, and in patients above age of five if renal scintigraphy showed evidence of scarring. Of the 29 UTI patients 10 (34%) had VUR. Of the patients with VUR, seven were below age of five while three were above five. Renal scarring was found in 3/7 patients with VUR below age of five years, but was in all patients with VUR above age of five years. All patients with grade 3 and 4 reflux nephropathy had renal scarring, while it was found in half of the patients with grade 1 and 2 reflux. We conclude that in UTI patients VUR is not uncommon finding, which needs further investigations and follow-up.
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