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Practical approach to screen vesicoureteral reflux after a first urinary tract infection
María Álvarez Fuente1, Talía Sainz Costa1, Begoña Santiago García1
1Department of Pediatrics, Hospital Clínico San Carlos, Madrid, Spain.
Insights
Renal ultrasound (RUS) effectively screens for pediatric vesicoureteral reflux (VUR) after a first urinary tract infection (UTI). A normal RUS in infants under two years old means further imaging like voiding cystourethrography (VCUG) is not needed.
Area of Science:
- Pediatric Urology
- Diagnostic Imaging
- Nephrology
Background:
- Vesicoureteral reflux (VUR) is a prevalent congenital condition in children.
- The initial diagnostic step for VUR post-urinary tract infection (UTI) is typically renal ultrasound (RUS).
- Voiding cystourethrography (VCUG) and dimercaptosuccinic acid (DMSA) scans are established methods for VUR detection.
Purpose of the Study:
- To assess the utility of RUS as a primary screening tool for VUR in infants under two years old.
- To determine if a normal RUS can obviate the need for subsequent, more invasive imaging studies.
- To reduce unnecessary procedures in the diagnosis of VUR.
Main Methods:
- Retrospective analysis of medical records and imaging data from infants (<2 years) experiencing their first UTI.
- Evaluation of the diagnostic performance (sensitivity, specificity, negative predictive value) of RUS and DMSA for VUR.
- Comparison of RUS findings with VCUG results.
Main Results:
- Among 155 infants with their first UTI, VUR was diagnosed in 21% (14.5% low-grade, 6.5% high-grade).
- A normal RUS correlated with a 98% absence of or low-grade VUR.
- Abnormal findings on RUS were significantly associated with high-grade VUR (P < 0.001).
Conclusions:
- Renal ultrasound (RUS) serves as an effective initial screening method for VUR in infants following their first UTI.
- Routine VCUG or DMSA scans are not recommended for infants with a normal RUS result.
- VCUG should be reserved for cases with abnormal RUS findings or recurrent UTIs.
Introduction:
Vesicoureteral reflux (VUR) is a common pediatric urologic disorder. After the first urinary tract infection (UTI), imaging studies are recommended, starting with a renal ultrasound (RUS). Voiding cystourethrography (VCUG) and dimercaptosuccinic acid (DMSA) scan are the other main radiologic studies used to detect VUR. We evaluated the use of RUS as a screening method for VUR in children below 2 years of age, in order to avoid unnecessary VCUG.
Materials And Methods:
Medical records and imaging studies of infants (<2 years) who had their first UTI in a 6 year period were retrospectively reviewed. We evaluated the sensitivity, specificity, and negative predictive values of RUS and DMSA for diagnosing VUR.
Results:
Among 155 children (51% males) with their first UTI, 148 RUS were performed, 128 VCUG and 29 DMSA. VUR was detected in 21% patients; 14.5% low grade and 6.5% high grade. One hundred and twenty-one patients underwent both RUS and VCUG, 101 RUS were normal and 20 abnormal. Of the normal RUS 98% had no or low grade VUR. Among those with an abnormality on RUS 30% had high grade VUR (P < 0.001).
Conclusions:
After the first UTI in infants (<2 years) RUS is a good screening method for VUR. Among such shildren with a normal RUS, we do not recommend VCUG or DMSA. In our opinion, VCUG should be performed only in patients with abnormal findings in RUS or in recurrent UTI.
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