Voiding cystourethrography is mandatory in infants with febrile urinary tract infection

Area of Science:

• Pediatric Nephrology
• Urology
• Diagnostic Imaging

Background:

• Vesicoureteral reflux (VUR) and febrile urinary tract infections (UTIs) in infants are risk factors for renal scarring.
• Renal scars can lead to long-term complications like hypertension and chronic kidney disease.
• Voiding cystourethrography (VCUG) is traditionally used to detect VUR in infants after febrile UTIs.

Purpose of the Study:

• To evaluate the efficacy of a stratified approach versus a non-stratified approach in identifying infants at risk for renal scarring.
• To determine if a stratified approach, which does not perform VCUG on all patients, is justified.
• To verify the necessity of universal VCUG screening in infants following their first febrile UTI.

Main Methods:

• Retrospective review of medical records for 306 infants with first febrile UTIs.
• Comparison of VUR detection rates between a non-stratified approach (all patients receive VCUG) and a stratified approach (VCUG only for high-risk patients).
• Assessment of renal bladder ultrasonography sensitivity in detecting VUR and predicting renal scarring.

Main Results:

• The non-stratified approach detected VUR in 40.4% of infants, while the stratified approach detected it in only 27.1%.
• This difference in VUR detection rates between the two approaches was statistically significant (p = 0.02).
• Renal bladder ultrasonography showed low sensitivity (45.7% for VUR, 52.9% for scarring).

Conclusions:

• The stratified approach significantly underdiagnosed VUR compared to the non-stratified approach.
• The findings do not support the use of a stratified approach for identifying infants at risk of renal scarring.
• Universal VCUG screening is recommended for all infants following their first febrile UTI to ensure accurate VUR diagnosis and prevent potential renal damage.