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Published on: August 14, 2019
Voiding cystourethrography as a predictor of reflux nephropathy in children with urinary-tract infection
M Hellström1, B Jacobsson, S Mårild
1Department of Radiology, Sahlgren's Hospital, Gothenburg, Sweden.
Insights
Most children with kidney damage after urinary tract infections have vesicoureteral reflux. However, some children may develop renal damage even without reflux, highlighting the need for careful monitoring.
Area of Science:
- Pediatric Nephrology
- Diagnostic Imaging
- Infectious Diseases
Background:
- Urinary tract infections (UTIs) in children can lead to renal damage (scarring).
- Vesicoureteral reflux (VUR) is commonly associated with renal damage after UTIs.
- Voiding cystourethrography (VCUG) is the standard initial radiologic study for children with UTIs.
Purpose of the Study:
- To evaluate the sensitivity and predictive value of VUR during VCUG in identifying children at risk for renal damage.
- To assess the occurrence of renal damage in children with and without VUR following a first-time febrile UTI.
Main Methods:
- Eighty-four children (2 months to 6 years) with a first-known, febrile, nonobstructive UTI underwent VCUG and urography.
- VUR was identified in 27% of children, and renal damage was observed in 12% of children.
- VCUG results were correlated with the presence or development of renal damage.
Main Results:
- The sensitivity of VUR as a marker for renal damage was 80%, with a specificity of 74%.
- The positive predictive value of VUR was 30%, and the negative predictive value was 96%.
- Importantly, 2 children (and 4 kidneys) with renal damage showed no VUR on initial VCUG.
Conclusions:
- While VUR during VCUG is a strong indicator of renal damage risk after childhood UTI, it is not universally present.
- A small but significant risk of renal damage exists even in the absence of VUR, necessitating comprehensive evaluation.
- VCUG remains a crucial diagnostic tool, but its limitations in predicting all cases of renal damage should be recognized.
Abstract:
Most children who develop renal damage (scarring) after urinary-tract infection have vesicoureteral reflux. Voiding cystourethrography is therefore usually recommended as the initial radiologic study in children with urinary-tract infection. However, renal damage may occur also in the absence of reflux. The aim of this investigation was to determine the sensitivity and predictive value of reflux during voiding cystourethrography in identifying children at risk for renal damage. Eighty-four consecutive children, 2 months to 6 years old, with nonobstructive, first-known, febrile urinary-tract infection underwent voiding cystourethrography and urography. Twenty-seven (32%) had reflux and 10 (12%) had or developed renal damage. Two of the children and four of the kidneys with renal damage had no reflux at initial examination. The sensitivity of reflux as a marker for renal damage was 80%, specificity was 74%, positive predictive value was 30%, and negative predictive value was 96%. Thus, most children who develop renal damage after urinary-tract infection have reflux during voiding cystourethrography. However, there is a risk, albeit small, for renal damage to occur in the absence of reflux.
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