Local Trends in the Evaluation and Treatment of Urinary Tract Infections and Vesicoureteral Reflux in Children

Vereen, Rasheda J.; Kogan, Barry A.; Feustel, Paul J.

doi:10.1016/j.urpr.2016.03.006

Cited by 2 publications

(1 citation statement)

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“…This is consistent with previous reports using single-institutional and claims data. 3,11 In addition, there was no association between year of presentation and odds of being diagnosed with VUR grade >2. This may suggest that VCUG studies are simply being performed less frequently rather than more selectively in an approach that would result in a grade migration effect (ie higher proportion with dilated collecting system) or higher yield of VUR diagnosis per VCUG study.…”

Section: Discussionmentioning

confidence: 93%

Changes in Clinical Presentation and Renal Outcomes among Children with Febrile Urinary Tract Infection: 2005 vs 2015

et al. 2021

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Purpose: Recent studies have demonstrated trends of decreasing voiding cystourethrogram utilization rates and delayed vesicoureteral reflux diagnosis in some children. It is possible that such delays could lead to more children sustaining repeated episodes of febrile urinary tract infection, and potential kidney injury, prior to diagnosis and treatment. Materials and Methods: Using single institutional, cross-sectional cohorts of patients in 2 time periods (2005 and 2015), we compared clinical presentation and renal outcomes among patients 13 years and younger with history of febrile urinary tract infection presenting for initial voiding cystourethrogram. Outcomes included 1) recurrent urinary tract infection, 2) presence of vesicoureteral reflux, 3) grade of vesicoureteral reflux, and 4) renal scarring. Associations between year of presentation and outcomes of recurrent urinary tract infection and vesicoureteral reflux diagnosis were evaluated using multivariable logistic regression models. For the outcome of renal scarring, a logistic regression model was fitted for propensity score matched cohorts. Results: Compared to children presenting in 2005, those in 2015 had 3 times the odds of recurrent urinary tract infection (OR 3.01, 95% CI 2.18e4.16, p <0.0001). Time period was not associated with the odds of vesicoureteral reflux (OR 0.98, 95% CI 0.77e1.23, p[0.85). Those in 2015 were more likely to present with vesicoureteral reflux grade >3 (OR 2.22, 95% CI 1.13e4.34, p[0.02) but not vesicoureteral reflux grade >2 (OR 1.11, 95% CI 0.74e1.67, p[0.60). Renal scarring was more common among children presenting in 2015 (OR 2.9, 95% CI 1.03e8.20, p[0.04). Conclusions: Compared to 2005, children presenting in 2015 for post-urinary tract infection voiding cystourethrogram have increased likelihood of recurrent urinary tract infection and renal scarring, despite similar likelihood of vesicoureteral reflux diagnosis.

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Section: Discussionmentioning

confidence: 93%