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Long-term follow up to determine the prognostic value of imaging after urinary tract infections. Part 1: Reflux
M V Merrick1, A Notghi, N Chalmers
1Department of Nuclear Medicine, Western General Hospital NHS Trust, Edinburgh.
Insights
Vesicoureteric reflux (VUR) is a risk factor for progressive kidney damage in children over 1 year old and girls. Micturating cystourethrography (MCU) has a higher false negative rate than indirect isotope voiding study (IVS) for detecting VUR.
Area of Science:
- Pediatric Nephrology
- Urology
- Diagnostic Imaging
Background:
- Urinary tract infections (UTIs) are common in children.
- Vesicoureteric reflux (VUR) is a known risk factor for renal scarring and damage.
- Accurate diagnosis of VUR is crucial for appropriate management and preventing progressive renal damage.
Purpose of the Study:
- To correlate the prevalence of VUR at presentation with progressive renal damage in children with UTIs.
- To evaluate the risk factors for progressive renal damage in relation to VUR.
- To compare the diagnostic accuracy of micturating cystourethrography (MCU) and indirect isotope voiding study (IVS) in detecting VUR.
Main Methods:
- Retrospective analysis of 3646 children with confirmed UTIs.
- Correlation of VUR prevalence at presentation with renal damage over 2-16 years of follow-up.
- Comparison of MCU and IVS in diagnosing VUR and its association with renal damage.
Main Results:
- Progressive renal damage occurred in children with and without VUR; VUR was not a risk factor in boys under 1 year but was in boys over 1 year and girls.
- Children with no VUR detected by MCU had a substantially greater risk of renal damage than those with no VUR detected by IVS, suggesting a higher false negative rate for MCU.
- Dilatation of the renal pelvis on ultrasound increased the risk of damage only when associated with VUR.
Conclusions:
- VUR is a significant risk factor for progressive renal damage in specific pediatric populations.
- MCU may have a higher false negative rate than IVS for detecting VUR, impacting risk assessment.
- Imaging findings like VUR and renal pelvis dilatation require careful interpretation in the context of UTI management.
Abstract:
In 3646 children with at least one confirmed urinary tract infection the prevalence of vesicoureteric reflux at presentation was correlated with progressive renal damage during follow up of not less than two and up to 16 years. Reflux was not demonstrated either at presentation or at any subsequent time in almost one half of the children who suffered progressive renal damage and was not a risk factor for progressive renal damage in boys under 1 year. It was an important risk factor in boys over 1 year and in girls of any age. The risk of progressive renal damage in children in whom micturating cystourethrography (MCU) did not reveal vesicoureteric reflux was substantially greater than in those who indirect isotope voiding study (IVS) did not show reflux. The risk of deterioration for those in whom reflux was demonstrated was similar for both techniques. This discrepancy indicates an appreciably higher false negative rate for the MCU than the IVS. Dilatation of the renal pelvis detected by ultrasound was associated with a significantly increased risk of progressive damage only when associated with reflux, but most children with progressive damage did not have a dilated collecting system at presentation.