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Published on: October 12, 2017
Vesicoureteral reflux in children with suspected and proven urinary tract infection
Annukka Hannula1, Mika Venhola, Marjo Renko
1Department of Paediatrics, University of Oulu, Oulu, Finland. annukka.hannula@oulu.fi
Insights
Vesicoureteral reflux (VUR) prevalence is similar in children with and without urinary tract infections (UTI). This suggests routine voiding cystourethrography (VCUG) after UTI may not be necessary for all children.
Area of Science:
- Pediatric Nephrology
- Urology
- Diagnostic Imaging
Background:
- Urinary tract infections (UTIs) are common in children.
- Vesicoureteral reflux (VUR) is often investigated after UTIs, but its association is debated.
- Current guidelines recommend voiding cystourethrography (VCUG) after UTI, but evidence is evolving.
Purpose of the Study:
- To estimate the prevalence of VUR and significant renal ultrasonography (US) abnormalities in children with proven and suspected UTIs.
- To evaluate the association between VUR and UTI diagnosis reliability.
- To challenge traditional estimates of VUR occurrence and diagnostic recommendations.
Main Methods:
- Retrospective review of medical reports for 2,036 children undergoing renal US and 1,185 children undergoing VCUG.
- Classification of UTI diagnoses into five reliability classes based on urine culture.
- Statistical analysis to compare VUR prevalence and US abnormalities between UTI groups.
Main Results:
- VUR prevalence was similar in children with proven UTI (37.4%) and false UTI (34.8%).
- VUR prevalence decreased with increasing age.
- Clinically significant US abnormalities were more frequent in proven UTI cases (14.9%) than false UTI cases (7.6%).
Conclusions:
- VUR is not significantly associated with UTI in children.
- The occurrence of VUR in children without UTI is higher than previously estimated.
- Routine VCUG after UTI may not be indicated for all children, warranting a re-evaluation of current guidelines.
Abstract:
The aim of this study was to estimate the prevalence of vesicoureteral reflux (VUR) and clinically significant ultrasonography (US) abnormalities in a large group of children with proven and suspected urinary tract infection (UTI). The medical reports on renal US and voiding cystouretrographies (VCUG) of 2,036 children were reviewed. Renal US was performed on all children and VCUG on 1,185 children (58%). Based on the urine culture data, the UTI diagnoses were classified into five reliability classes (proven, likely, unlikely, false and no microbial data). The UTI diagnose was considered proven in 583/2036 (28.6%) and false in 145 (7.1%) cases. The prevalence of VUR was similar among those with proven and false UTI [37.4 vs. 34.8%; relative risk (RR) 1.08, 95% confidence intervals (95% CI) 0.7-1.7, P = 0.75] and decreased with increasing age (P = 0.001). Clinically significant US abnormalities occurred in 87/583 (14.9%) cases with proven UTI and significantly less often (11/145, 7.6%) in the false UTI class (RR 1.96, 95% CI 1.1-3.6, P = 0.02). Our finding supports the claim that VUR is not significantly associated to UTI and that its occurrence among children even without UTI is significantly higher than traditional estimates. This challenges the recommendations of routine VCUG after UTI.
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