International system of radiographic grading of vesicoureteric reflux

Lebowitz, Robert L.; Olbing, H; Parkkulainen, K V; Smellie, J. M.; Tamminen-Möbius, T.

doi:10.1007/bf02388714

Cited by 1,081 publications

(514 citation statements)

References 7 publications

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“…21 VUR then was classified as no VUR (grade 0), low-grade VUR (grades 1 and 2), and high-grade VUR (grade Ն3). 12,13,20,22 PCT At admission, the patient's serum PCT was measured prospectively using the LUMItest PCT immunoluminometric assay (BRAHMS, Hennigsdorf, Germany).…”

Section: Outcome Definitionmentioning

confidence: 99%

Procalcitonin as a Predictor of Vesicoureteral Reflux in Children With a First Febrile Urinary Tract Infection

Leroy¹

2005

Pediatrics

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ABSTRACT. Objective. A first febrile urinary tract infection leads to the diagnosis of vesicoureteral reflux in 20% to 40% of children. Systematic voiding cystourethrography then is recommended. However, for 60% to 80% of the children, voiding cystourethrography is a posteriori normal. Moreover, it is irradiating, painful, and expensive. Thus, selective approaches are needed. Because procalcitonin has been shown to be associated with severe pyelonephritis and renal scars, which are correlated to vesicoureteral reflux, we analyzed its relationship with vesicoureteral reflux.Methods. A retrospective hospital-based cohort study included all children who were 1 month to 4 years of age and had a first febrile urinary tract infection. Univariate and multivariate analyses were performed.Results. Among 136 patients included, 25% had vesicoureteral reflux. The median procalcitonin concentration was significantly higher in children with reflux than in those without (1.2 vs 0.6 ng/mL). High procalcitonin (>0.5 ng/mL) was associated with reflux (odds ratio [OR]: 4.6; 95% confidence interval [CI]: 1.6 -16.2). After logisticregression adjustment for all potential confounders, the association remained significant (OR: 4.9; 95% CI: 1.7-14.0). The relationship was stronger for high-grade (>3) reflux (OR: 8.7; 95% CI: 1.2-382) than low-grade reflux (OR: 3.6; 95% CI: 1.1-15.3). High procalcitonin sensitivities were 85% (95% CI: 70 -94) and 92% (95% CI: 65-99) for all-grade and high-grade reflux, respectively, with 44% specificity (95% CI: 35-54).Conclusion. High procalcitonin is a strong and independent predictor of vesicoureteral reflux and could be used to identify low-risk patients to avoid unnecessary voiding cystourethrography. U rinary tract infection (UTI) is one of the most frequent bacterial infections in children. 1 It has been estimated that 7% of girls and 2% of boys will have a UTI before 6 years of age. 2 Vesicoureteral reflux (VUR) is diagnosed at the time of the first febrile UTI in 20% to 40% of children. 3 VUR is a risk factor for relapsing UTI, renal scarring, hypertension, and renal failure. 3 Thus, pediatric societies 4-6 have recommended systematic voiding cystourethrography after the first febrile UTI in children. However, for 60% to 80% of the children, voiding cystourethrography is a posteriori normal. Moreover, this procedure has been associated with a risk for iatrogenic UTI 7 and is irradiating, particularly for gonads, 8 painful, 9 and expensive. 10 Therefore, it would be useful to be able to predict the absence of VUR so as to avoid unnecessary voiding cystourethrography. 8 Two predictive tools have been proposed to define selective approaches for voiding cystourethrography. Renal ultrasonography alone, regardless of the criteria chosen, was shown to be poorly sensitive for VUR prediction. 11-14 A highly sensitive VUR risk score, combining clinical, biological, and radiologic variables, was also proposed, 15 but we have shown that this score was poorly reproducible. 16 Thus, new predictors of VUR afte...

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Section: Outcome Definitionmentioning

confidence: 99%

Procalcitonin as a Predictor of Vesicoureteral Reflux in Children With a First Febrile Urinary Tract Infection

Leroy¹

2005

Pediatrics

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“…Vesicoureteral reflux was graded by using the system of the International Reflux Study in Children. [5] If VCUG showed bilateral VUR, the highest VUR grade was utilized for analysis. Estimated glomerular filtration rate (eGFR) was calculated by the Schwartz formula [6] and CKD was classified according to the Kidney Disease Outcomes Quality Initiative Guideline.…”

Section: Methodsmentioning

confidence: 99%

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

Doğan

Koyun

Aksoy

et al. 2018

Turkish Journal of Urology

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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.

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“…Spot films were taken at full bladder capacity, during voiding and post-voiding. Refluxes were graded according to the guidelines of the International Reflux Study in Children [9]. The same radiologist performed all fluoroscopies unaware of PD-VUS findings.…”

Section: Methodsmentioning

confidence: 99%

Discrepancy between power-Doppler voiding urosonography and voiding cystourethrography is not relevant for the management of primary vesicoureteric reflux

Castagnetti

Cimador

Tudisco

et al. 2006

Journal of Pediatric Surgery

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International system of radiographic grading of vesicoureteric reflux

Cited by 1,081 publications

References 7 publications

Procalcitonin as a Predictor of Vesicoureteral Reflux in Children With a First Febrile Urinary Tract Infection

Procalcitonin as a Predictor of Vesicoureteral Reflux in Children With a First Febrile Urinary Tract Infection

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

Discrepancy between power-Doppler voiding urosonography and voiding cystourethrography is not relevant for the management of primary vesicoureteric reflux

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