Vesicoureteral reflux: subpopulations of patients defined by clinical variables

Gelfand, Michael J.; Koch, Bernadette L.; Cordero, Gretchen G.; Salmanzadeh, Amir; Gartside, Peter S.

doi:10.1007/s002470050028

Cited by 14 publications

(5 citation statements)

References 15 publications

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“…In a historical German study in which a VCUG was performed on children with no urinary tract pathology, the prevalence of VUR was >60% in infants and decreased with increasing age [25]. Several authors have confirmed the finding that VUR resolves spontaneously in most children as they mature, and this maturation phenomenon was again documented here [26,27]. In animal experiments, VUR has been found to be common among infant mammals, with a prevalence of almost 100% in rats.…”

Section: Discussionsupporting

confidence: 48%

Vesicoureteral reflux in children with suspected and proven urinary tract infection

et al. 2010

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The aim of this study was to estimate the prevalence of vesicoureteral reflux (VUR) and clinically significant ultrasonography (US) abnormalities in a large group of children with proven and suspected urinary tract infection (UTI). The medical reports on renal US and voiding cystouretrographies (VCUG) of 2,036 children were reviewed. Renal US was performed on all children and VCUG on 1,185 children (58%). Based on the urine culture data, the UTI diagnoses were classified into five reliability classes (proven, likely, unlikely, false and no microbial data). The UTI diagnose was considered proven in 583/2036 (28.6%) and false in 145 (7.1%) cases. The prevalence of VUR was similar among those with proven and false UTI [37.4 vs. 34.8%; relative risk (RR) 1.08, 95% confidence intervals (95% CI) 0.7-1.7, P = 0.75] and decreased with increasing age (P = 0.001). Clinically significant US abnormalities occurred in 87/583 (14.9%) cases with proven UTI and significantly less often (11/145, 7.6%) in the false UTI class (RR 1.96, 95% CI 1.1-3.6, P = 0.02). Our finding supports the claim that VUR is not significantly associated to UTI and that its occurrence among children even without UTI is significantly higher than traditional estimates. This challenges the recommendations of routine VCUG after UTI.

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Section: Discussionsupporting

confidence: 48%

Vesicoureteral reflux in children with suspected and proven urinary tract infection

et al. 2010

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“…Overall incidence of VUR by this study is (25%) this agree with other studies obtained by other which shows incidence of (26-53%) (18)(19)(20) Various degrees of dilatation of the collecting system of the kidney seen on renal ultrasound are often reported. Three studies that examined significance of these findings in children.…”

Section: Discussionsupporting

confidence: 91%

Value of Ultrasound in Children with Urinary Tract Infection and Vesicouretric Reflux

Hussein

2013

Kufa Jour. Nurs. Sci.

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Objectives: the study aims to assess different urological abnormalities associated with UTI in children & to determine the value of ultrasound in vesicoureteral reflux (VUR). Methodology: Retrospective study of the ultrasound and micturating cystourethrogram (MCUG) results of 80 children under 5 years of age with clinically labelled cases of first time urinary tract infection (UTI) over a 2 years period. Thirty cases had excretory urography tailored according to the case. The study assesses different renal, uretric and urinary bladder abnormalities associated with first time UTI in children. Ultrasound findings were also assess VUR and suggest its presence if dilatation of the pelvi-calyces, dilatation of the ureters, or dilatation of the collecting system of one or both kidneys was reported. Statistical analysis used include sensitivity, specificity, positive predictive value and negative predictive value. Results: A total of 80 patients (20 days-5 years) (median age 18 months), 42 (52% were female), 38 (48% were males). In analysis of US findings: hydronephrosis and urinary bladder mucosa thickenings (cystitis) each 28.7 % were the commonest, renal stones and congenital anomalies: 11.2 % and 10% respectively. The urinary bladder stones were 6.2%. The prevalence of VUR was 25%. Ultrasound findings were positive for VUR in 8 of 20 patients with confirmed VUR on MCUG, and positive in 15 of 60 patients without VUR on MCUG. of 12 patients who had a normal ultrasound but showed VUR on MCUG, 7 had grade II reflux, 3 grade III reflux, and two grade IV reflux. The sensitivity and specificity of ultrasound in suggesting VUR were 40% and 80%, respectively. The positive predictive value of ultrasound in suggesting VUR was 34%; the negative predictive value was 83%. Conclusions: Uultrasound useful to evaluate children with different urological abnormalities associated with UTI in children but its neither sensitive nor specific for VUR in children with UTI. Clinician should not depend on ultrasound only for diagnosis of VUR and must proceed to other like voiding colour Doppler US with echo enhancement or MCUG

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“…Given the good prognosis for children with VUR, the practice of detecting reflux after a UTI has been recently questioned [19], [20], [21], [22], [23] and [24]. Currently, no evidence clearly indicates that interventions (medical or surgical) for VUR confer benefit, albeit there is also a lack of evidence suggesting that interventions are not beneficial [12], [25], [26], [27], [28], [29], [30], [31], [32] and [33].…”

Section: Resultsmentioning

confidence: 99%

The accuracy and health risks of a voiding cystourethrogram after a febrile urinary tract infection

Spencer

Bates

Mahan

et al. 2012

Journal of Pediatric Urology

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Objective Physicians often defer obtaining a voiding cystourethrogram (VCUG) after the diagnosis of urinary tract infection (UTI) due to concerns regarding increased health risks and inflated rates of vesicoureteral reflux (VUR). This study examines the health risks and accuracy of VCUG testing after diagnosis of a febrile UTI. Patients and methods A retrospective review was conducted of children aged 0–18 years admitted to Nationwide Children’s Hospital with a febrile UTI in 1995–2000. Children were divided into two cohorts – those who had a VCUG performed within 1 week of diagnosis (early VCUG cohort) and those who had a VCUG performed more than 1 week after diagnosis (late VCUG cohort). All children were followed for an additional 5 years after hospital discharge. Results The incidence and severity of VUR were similar in patients that underwent early and late VCUG testing. Patients who underwent early VCUG testing showed no sign of worsening illness after the test was performed. During the 5-year follow up, these patients did not have higher rates of return emergency department visits or hospital readmission compared to those who received late VCUG testing. Conclusions The rate of VUR detection does not increase with early VCUG testing. Early VCUG testing does not lead to increased risk of bacterial dissemination or urosepsis.

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Vesicoureteral reflux: subpopulations of patients defined by clinical variables

Abstract: Girls with UTI should not be considered to be a homogeneous group. The frequency of VUR is related to T(max) and inversely to age. Data about these subpopulations should be used in deciding which girls should undergo cystography.

Cited by 14 publications

References 15 publications

Vesicoureteral reflux in children with suspected and proven urinary tract infection

Vesicoureteral reflux in children with suspected and proven urinary tract infection

Value of Ultrasound in Children with Urinary Tract Infection and Vesicouretric Reflux

The accuracy and health risks of a voiding cystourethrogram after a febrile urinary tract infection

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