Urinary tract infection and vesicoureteric reflux in children

A retrospective study of 74 children with Urinary Tract Infection (UTI) were evaluated for the prevalence of vesicoureteric reflux (VUR) at a tertiary hospital in Dhaka, Bangladesh from 2003 to 2006. There were 45 (60%) girls and 29 (40%) boys; 58 (78%) were at an average age between 1-5 years, 11 (15%) were between 0-1 year and five (7%) were more than 5 years of age. All patients were documented to have UTI by history and laboratory investigations. There were 27 (36%) patients who had acute pyelonephritis at the initial clinical presentation and fourty seven (64%) patients had recurrent UTI. Thirty two (43%) patients had vesicoureteric reflux; fifteen (47%) had it bilaterally (VUR); and 13 (41%) had renal scarring. Five (7%) patients who had renal scarring were with- out reflux. Twenty three (72%) of the VUR patients had mild to moderate reflux (grade 1-3) and nine (28%) had severe reflux (grade 4-5). The age of the patients with VUR was below one year in 13 (40%), between 1 and 5 years in 17 (53%) and between 6 and 12 years 2 (7%) patients. There were 9 (33%) patients with acute pyelonephritis who had reflux. Follow-up of the VUR patients showed that reflux disappeared with out surgical intervention in 14 (44%), improved in three (9%) to lower grade and worsened in two (6%) to higher grade. Five (16%) patients underwent ureteral re-implantation; all the patient of VUR had recurrent UTI and were more than one year of age. While on chemoprophylaxis, two of the reimplanted patients developed break-through UTI. None of the study patients developed new scars, hypertension or renal failure during follow-up; the duration of follow-up was from 6 months to 3 years. Children with UTI below 6 years of age have high incidence of reflux and scarring with specially in patients with acute pyelonephritis.