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The relationship between urinary tract infections and vesicoureteral reflux in Turkish children
Harun Peru1, Sevcan Azime Bakkaloglu, Oguz Soylemezoglu
1Department of Pediatric Nephrology, School of Medicine, Gazi University, Besevler, Ankara, 06540, Turkey. harunperu@gmail.com
Insights
Vesicoureteral reflux (VUR) is common in children with urinary tract infections (UTIs), including first-time infections. Early VUR detection is crucial as it correlates with renal scarring, especially in severe cases.
Area of Science:
- Pediatric Nephrology
- Urology
- Infectious Diseases
Background:
- Early detection of renal scar development risk in children post-urinary tract infection (UTI) is vital for preventing renal functional impairment.
- Vesicoureteral reflux (VUR) is a key factor in renal scarring, necessitating prompt identification and management.
Purpose of the Study:
- To determine the prevalence of VUR and associated renal scar formation in children with acute pyelonephritis (APN), first afebrile UTI, and recurrent afebrile UTIs.
- To assess the relationship between VUR grades and renal scarring incidence.
Main Methods:
- Retrospective analysis of 642 children with UTIs, enrolling 278 into three groups: APN, first afebrile UTI, and recurrent afebrile UTIs.
- Vesicoureteral reflux (VUR) prevalence and renal scarring were assessed in each group.
- Correlation between VUR grades and renal scarring was evaluated.
Main Results:
- VUR prevalence was similar across all groups (22.7%–26.4%).
- Renal scarring was significantly lower in children with their first afebrile UTI compared to other groups (P < 0.05).
- Renal scarring was higher in patients with VUR (37.1%) versus without VUR (14.3%), and markedly higher in grades 4-5 VUR (61.5%) than grades 1-3 VUR (30.6%).
Conclusions:
- Vesicoureteral reflux (VUR) is present in approximately one-quarter of children experiencing their first afebrile UTI.
- Given the consistent VUR prevalence across UTI types, all UTIs, both lower and upper, require thorough evaluation.
- Early and careful assessment of all UTIs is recommended to identify VUR and mitigate risks of renal scarring.
Abstract:
Early determination of renal scar development risk in children following first urinary tract infection (UTI) and early detection and treatment of vesicoureteral reflux (VUR) are important to prevent renal functional impairment. The aim of this study was to determine the prevalence of VUR and associated renal scar formation, in children who had acute pyelonephritis (APN), first afebrile UTI, and recurrent afebrile UTIs. Patient records of 642 children having UTI were scrutinized and 278 out of 642 were enrolled in this study. The patients were divided into three groups: Group 1, patients with APN (n = 73); Group 2, patients with the first afebrile UTI (n = 88); and group 3, patients with recurrent afebrile UTIs (n = 117). Among these groups, VUR prevalence did not differ significantly (group 1: 24.6%, group 2: 22.7%, and group 3: 26.4%. Renal scarring was detected in 19.3% of the patients and was remarkably lower in group 2 when compared with the other two groups (P < 0.05). Renal scarring was found in 37.1% of the patients with VUR, whereas it was found in 14.3% of patients without VUR. Renal scarring incidence was remarkably higher in patients with grades 4-5 VUR (61.5%) compared with those with grades 1-3 VUR (30.6%) (P = 0.055). In conclusion, since VUR was demonstrated in as many as one-quarter of patients with the first afebrile UTI and VUR incidence did not differ significantly among the groups, all UTIs, lower and upper ones, should be carefully evaluated.
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