Risk Factors for Vesicoureteral Reflux in Children with Upper and Lower Urinary Tract Infections
Ipek Kaplan Bulut *
Ege University, Faculty of Medicine, Department of Pediatric Nephrology,Turkey.
Nida Dincel
Ege University, Faculty of Medicine, Department of Pediatric Nephrology,Turkey.
Mustafa Orhan Bulut
Ege University, Faculty of Medicine, Pediatric Department,Turkey.
Betul Sozeri
Ege University, Faculty of Medicine, Pediatric Department,Turkey.
Sema Rala
Ege University, Faculty of Medicine, Pediatric Department,Turkey.
Gokben Kayacan
Tepecik Education and Research Hospital, Emergency Department, Turkey.
Zubeyir Hasan Gun
Emory University, Medical Faculty, Pediatric Department,USA.
Sevgi Mir
Ege University, Faculty of Medicine, Department of Pediatric Nephrology,Turkey.
*Author to whom correspondence should be addressed.
Abstract
Objective: Urinary tract infections (UTIs) are common in children and may signal vesicoureteral reflux (VUR). This study aimed to identify the risk factors associated with VUR and to emphasize value of diagnostic imaging studies in children.
Methods: This study was assessed 173 medical records of children who had first-time UTI in Ege University Pediatric Nephrology Department between January 2008 and January 2010. Patients were divided into 2 groups according to localization of UTI infections. Patients with fever, elevated acute phase reactants, low urine osmolarity and positive urinary culture were defined as having an upper UTI (Group I). Patients without systemic symptoms were defined as having a lower UTI (Group II).
Results: Ultrasonography (US) findings were abnormal in 43.4% patients. Abnormal dimercaptosuccinic acid (DMSA) was detected in 45% of patients and VUR was found in 41%. US had 52.4% sensitivity and 64.4% specificity for cortical defects in DMSA, and 52.4% sensitivity and 46.4% specificity for VUR. In Group I, DMSA had 70% sensitivity and 70% specificity for reflux in voiding cystourethrography. In Group II, US had 53% sensitivity and 48% specificity for cortical defects in DMSA, and 50% sensitivity and 41% specificity for VUR. DMSA had 62.5% sensitivity and 54.5% specificity for VUR.
Conclusions: Patients with UTIs should not be evaluated according to age and localization, only but rather according to all risk factors.
Keywords: Urinary tract infection, vesicoureteral reflux, diagnostic tools, renal scar, children