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Predictive value of clinical and laboratory variables for vesicoureteral reflux in children

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Abstract

We aimed to determine the predictability of clinical and laboratory variables for vesicoureteral reflux (VUR) in children with urinary tract infection (UTI). Data of children with febrile UTI who underwent voiding cystoureterography between 2002 and 2005 were evaluated retrospectively for clinical (age, gender, fever ≥38.5°C, recurrent UTI), laboratory [leukocytosis, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), pyuria, serum creatinine (SCr)] and imaging (renal ultrasonography) variables. Children with VUR (group 1) vs. no VUR (group 2) and children with high-grade (III–V) VUR (group 3) vs. no or low-grade (I–II) VUR (group 4) were compared. Among 88 patients (24 male), 38 had VUR and 21 high-grade VUR. Fever ≥38.5°C was associated with VUR [odds ratio (OR): 7.5]. CRP level of 50 mg/l was the best cut-off level for predicting high-grade VUR (OR 15.5; discriminative ability 0.89 ± 0.05). Performing voiding cystourethrography based on this CRP level would result in failure to notice 9% of patients with high-grade VUR, whereas 69% of children with no/low-grade VUR would be spared from this invasive test. In conclusion, fever ≥38°C and CRP >50 mg/l seem to be potentially useful clinical predictors of VUR and high-grade VUR, respectively, in pediatric patients with UTI. Further validation of these findings could limit unnecessary voiding cystourethrography.

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References

  1. Wald E (2004) Urinary tract infections in infants and children: a comprehensive overview. Curr Opin Pediatr 16:85–88

    Article  Google Scholar 

  2. Caione P, Ciofetta G, Collura G, Morano S, Capozza N (2004) Renal damage in vesico-ureteric reflux. BJU Int 93:591–595

    Article  CAS  Google Scholar 

  3. Silva JMP, Diniz JSS, Silva ACS, Azevedo MV, Pimenta MR, Oliveira EA (2006) Predictive factors of chronic kidney disease in severe vesicoureteral reflux. Pediatr Nephrol 21:1285–1292

    Article  Google Scholar 

  4. Lee JH, Son CH, Lee MS, Park YS (2006) Vesicoureteral reflux increases the risk of renal scars: a study of unilateral reflux. Pediatr Nephrol 21:1281–1284

    Article  Google Scholar 

  5. American Academy of Pediatrics, Committee on Quality Improvement, Subcommittee on Urinary Tract Infection (1999) The diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. Pediatrics 103:843–852

    Article  Google Scholar 

  6. Darge K, Riedmiller H (2004) Current status of vesicoureteral reflux diagnosis. World J Urol 22:88–95

    Article  Google Scholar 

  7. Wheeler D, Vimalachandra D, Hodson EM, Roy LP, Smith G, Craig JC (2003) Antibiotics and surgery for vesicoureteric reflux: a meta-analysis of randomized controlled trials. Arch Dis Child 88:688–694

    Article  CAS  Google Scholar 

  8. Gordon I, Barkovics M, Pindoria S, Cole TJ, Woolf AS (2003) Primary vesicoureteric reflux as a predictor of renal damage in children hospitalized with urinary tract infection: a systematic review and meta-analysis. J Am Soc Nephrol 14:739–744

    Article  Google Scholar 

  9. Westwood ME, Whiting PF, Cooper J, Watt IS, Kleijnen J (2005) Further investigation of confirmed urinary tract infection (UTI) in children under five years: a systematic review. BMC Pediatr 5:2

    Article  Google Scholar 

  10. Fanos V, Cataldi L (2004) Antibiotics or surgery for vesicoureteric reflux in children. Lancet 364:1720–1722

    Article  Google Scholar 

  11. Beetz R (2006) May we go on with antibacterial prophylaxis for urinary tract infections? Pediatr Nephrol 21:5–13

    Article  CAS  Google Scholar 

  12. Bensman A, Ulinski T (2006) International Vesicoureteral Reflux Study: unsolved questions remaining. Pediatr Nephrol 21:757–758

    Article  Google Scholar 

  13. Hellerstein S (2006) Acute urinary tract infection: evaluation and treatment. Curr Opin Pediatr 18:134–138

    Article  Google Scholar 

  14. Jodal U, Smellie JM, Lax H, Hoyer PF (2006) Ten-year results of randomized treatment of children with severe vesicoureteral reflux. Final report of the International Reflux Study in Cildren. Pediatr Nephrol 21:785–792

    Article  Google Scholar 

  15. Oostenbrink R, van der Heijden AJ, Moons KGM, Moll HA (2000) Prediction of vesico-ureteric reflux in childhood urinary tract infection: a multivariate approach. Acta Paediatr 89:806–810

    Article  CAS  Google Scholar 

  16. Leroy S, Marc E, Adamsbaum C, Gendrel D, Breart G, Chalumeau M (2006) Prediction of vesicoureteral reflex after a first febrile urinary tract infection in children: validation of a clinical decision rule. Arch Dis Child 91:241–244

    Article  CAS  Google Scholar 

  17. Leroy S, Adamsbaum C, Marc E, Moulin F, Raymond J, Gendrel D, Breart G, Chalumeau M (2005) Procalcitonin as a predictor of vesicoureteral reflux in children with a first febrile urinary tract infection. Pediatrics 115:e706–e709

    Article  Google Scholar 

  18. Burns MW, Burns JL, Krieger JN (1987) Pediatric urinary tact infection. Pediatr Clin North Am 34:1111–1120

    Article  CAS  Google Scholar 

  19. Lebowitz RL, Olbing H, Parkkulainen KV, Smellie JM, Tamminen-Mobius TE (1985) International system of radiographic grading of vesicoureteric reflux. International Reflux Study in Children. Pediatr Radiol 15:105–109

    Article  CAS  Google Scholar 

  20. Hoberman A, Charron M, Hickey RW, Baskin M, Kearney DH, Wald ER (2003) Imaging studies after a first febrile urinary tract infection in young children. N Engl J Med 348:195–202

    Article  Google Scholar 

  21. Hellerstein S (1995) Urinary tract infections: old and new concepts. Pediatr Clin North Am 42:1433–1457

    Article  CAS  Google Scholar 

  22. Sillen U (1999) Vesicoureteral reflux in infants. Pediatr Nephrol 13:355–361

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatrics, Division of Nephrology, Dokuz Eylul University, Medical Faculty, Balcova, 35340, Izmir, Turkey

    Alper Soylu, Belde Kasap, Korcan Demir, Mehmet Türkmen & Salih Kavukçu

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  1. Alper Soylu
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  2. Belde Kasap
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  3. Korcan Demir
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  4. Mehmet Türkmen
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  5. Salih Kavukçu
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Correspondence to Alper Soylu.

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Soylu, A., Kasap, B., Demir, K. et al. Predictive value of clinical and laboratory variables for vesicoureteral reflux in children. Pediatr Nephrol 22, 844–848 (2007). https://doi.org/10.1007/s00467-006-0418-6

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  • DOI: https://doi.org/10.1007/s00467-006-0418-6

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