Delayed diagnosis of primary vesicoureteral reflux in children with recurrent urinary tract infections: Diagnostic approach and renal outcomes

Abstract

Objective: In this study, we aimed to assess renal outcomes of delayed diagnosis of dilating primary vesicoureteral reflux (VUR) following recurrent febrile urinary tract infections (fUTIs) and its diagnostic imaging procedures. Material and methods:The medical records of patients who underwent ultrasonography (US), non-acute dimercaptosuccinic acid (Tc-99mDMSA) scintigraphy and voiding cystourethrography (VCUG), and who were older than 2 years at the time of VUR diagnosis were retrospectively reviewed.Results: A total of 32 children (female, n=27: 84.4%) with a mean age of 7.67±3.34 years at the time of diagnosis of VUR were included in the study. Grade III, IV, V VUR were found in 22%, 69%, and 9% of the patients, respectively. At the time of VUR diagnosis, abnormal US findings were detected in 75% of the cases. Tc-99mDMSA detected abnormalities in 83.9% (7 with a single scar, 7 with multiple lesions, 12 with reduced kidney function) of the patients. Estimated glomerular filtration rate of 3 patients with bilateral grade IV VUR was <75 mL/min/1.73 m 2 . In 5 patients (16%), VUR could not be predicted by US+DMSA scintigraphy (Grade IV VUR in 3 and Grade III in 2 cases ). The sensitivity in predicting VUR was 75.00% , respectively, for US alone and combined US+DMSA. Conclusion:VCUG should be performed routinely in addition to US and non-acute DMSA in all children referred with recurrent fUTIs. Awareness of childhood UTI in public and healthcare personnels should be increased in order to refer these patients at a early stage to pediatric urology and nephrology units.

Clinical manifestations, laboratory markers, and renal ultrasonographic examinations in 1-month to 12-year-old Iranian children with pyelonephritis: a six-year cross-sectional retrospective study

“…Thus, other diagnostic methods in combination with ultrasound should be used to monitor AP in pediatric patients due to the disadvantages such as the accepted low sensitivity, high operator dependence, and required expertise for the data interpretation [ 47 , 48 ]. It has been recently reported that the combined use of ultrasound with DMSA scintigraphy [ 49 ], voiding cystourethrogram [ 50 ], and technetium-99 m DMSA ( 99m Tc-DMSA) scintigraphy [ 51 , 52 ] can highly improve the diagnostic accuracy of AP among pediatric patients.…”

Risk factors affecting the prognosis of urinary tract infection in Chinese pediatric patients: Single‐center experience

“…VUR in children could generate varying degrees of renal damage such as renal scarring, poor kidney growth, renal dysplasia, proteinuria, hypertension and impaired renal function. Therefore, besides ultrasonography and dimercaptosuccinic acid scintigraphy, we recommended that voiding cystourethrography be performed routinely in children with recurrent UTI . Nordenstrom et al .…”