Child Kidney Dis.  2020 Apr;24(1):27-35. 10.3339/jkspn.2020.24.1.27.

Predictive Markers for Screening Renal Damagein Children with Urinary Tract infections andVesicoureteral Reflux

• Lee H
• Choi JH
• Kang DH
• Kim S
• Kang KS
• Han KH

• KMID: 2500358
• DOI: http://doi.org/10.3339/jkspn.2020.24.1.27

Abstract

Purpose
Urinary tract infections (UTIs) are the most common and serious bacterial infections in children. Therefore, early diagnosis of vesicoureteral reflux (VUR) for treatment planning and the identification of noninvasive markers that can predict renal injury are important in patients with UTIs. We analyzed the clinical features of pediatric UTIs commonly encountered by general practitioners and reinterpreted the blood tests and imaging findings to identify the important clinical predictive markers of VUR in order to selectively perform VCUG.
Methods
This retrospective study was performed among 183 children diagnosed with a UTI or acute pyelonephritis.
Results
The most significant predictor of high grade and bilateral VUR identified using area under the curve analyses was hydronephrosis on kidney ultrasound images with renal cortical defects on dimercaptosuccinic acid (DMSA) kidney scan simultaneously, followed by hydronephrosis only on kidney ultrasound.
Conclusion
The presence of hydronephrosis on kidney ultrasound images or cortical defects or asymmetric kidneys on the DMSA kidney scans can be predictive markers of VUR, reducing the need for VCUG. Our study can thus help minimize the exposure to radiation among patients through selective VCUG.

Keyword

Urinary tract infection; Children; Vesicoureteral reflux; Predictive marker