Prediction of Moderate and High Grade Vesicoureteral Reflux After a First Febrile Urinary Tract Infection in Children: Construction and Internal Validation of a Clinical Decision Rule

Abstract

A clinical decision rule was derived to enable a selective approach to cystography in children with urinary tract infection. The rule predicts high grade vesicoureteral reflux with approximately 85% sensitivity and avoids half of the cystograms that do not find reflux grade III or higher. Further validation is needed before its widespread use.

Serum Procalcitonin Level is a Useful Predictor of Dilating Vesicoureteral Reflux in Patients with First Febrile Urinary Tract Infection

“…Similar to our results Leroy and colleagues [25][26][27][28] have also shown that most patients with low-grade VUR had low procalcitonin concentration and did not need VCUG or RNC in the fi rst episode of febrile UTI. This association was assumed to be due to the increased risk of renal scarring with high-grade VUR is increased.…”

“…The association of PCT values with VUR in children with febrile UTI remains controversial [25][26][27][28] The current study shows a signifi cant difference in PCT values between children with and without VUR, in accordance to the previously published data [25][26][27][28][31][32][33][34] . An earlier multicenter study of 398 patients in 8 centers in 7 European countries, in which DMSA was not performed in all patients [26] and strongly showed that PCT is a predictor of VUR independently of its relationship with early parenchymal involvement regardless of the urine-collection technique used for the diagnosis of UTI.…”

“…The differences in the specifi city values between our study and theirs [25][26][27][28], could be explained keeping in consideration that they used sterile bags to collect urine in non-toilet rained children, which is not the recommended method. This could have led to selection bias, increasing the number of false-positive results for UTI and overestimating in particular the relationship between high-grade VUR and PCT.…”

“…So, our study followed a consistent plan of management for children with febrile UTI. While, the studies of Leroy et al [25][26][27][28], are secondary analyses of retrospective, multicenter cohorts a design that considered by the authors to be might have led to several biases. The greater proportion of children with all grades of VUR (48% versus 25-26%) and dilating VUR (33.7% versus 9-12%) in the current study compared with the studies by Leroy et al [25][26][27][28], may explain the higher sensitivity rate of predicting dilating VUR, with less false-negative cases in our study.…”

“…[25][26][27][28].However, this assumption still needs more confi rmatory studies. The aim of this prospective cohort study was to determine whether we can use serum procalcitonin concentration as a marker of VUR presence or VUR degree in hospitalized children with fi rst febrile UTI.…”