Vesicoureteral reflux: an accurate predictor of acute pyelonephritis in childhood urinary tract infection?
OBJECTIVE
To determine the association between vesicoureteral reflux (VUR) and the presence of acute pyelonephritis in children with urinary tract infections.


METHODS
The authors studied 150 consecutive patients less than 5 years of age with their first proved urinary tract infection. All patients underwent renal cortical scintigraphy (with technetium-99m dimercaptosuccinic acid or Tc-99m gluconate) and voiding cystourethrography (VCUG) to identify the presence of cortical defects and VUR, respectively.


RESULTS
Of 300 kidneys, 88 (29.3%) had a cortical defect at scintigraphy. Fifty-four of the 88 patients (61%) did not have VUR demonstrated at VCUG. Conversely, 72 of the 300 kidneys (24%) had VUR; of these, 38 (53%) had no cortical defect. The sensitivity of VCUG in helping predict a defect was 38.6%, and the specificity was 82.1%.


CONCLUSIONS
VUR (as shown by VCUG) and renal cortical scintigraphic defects frequently occur independently of each other. Renal cortical scintigraphy may be a more accurate predictor of patients at risk for scarring.
Ditchfield
M R
MR
Department of Radiology, Royal Childrens Hospital, Melbourne, Australia.
De Campo
J F
JF
Cook
D J
DJ
Nolan
T M
TM
Powell
H R
HR
Sloane
R
R
Grimwood
K
K
Cahill
S
S
D000208:Acute Disease; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007668:Kidney / Q000000981:diagnostic imaging; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011704:Pyelonephritis / Q000209:etiology*; D011859:Radiography; D011877:Radionuclide Imaging; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014521:Urethra / Q000000981:diagnostic imaging; D001743:Urinary Bladder / Q000000981:diagnostic imaging; D014552:Urinary Tract Infections / Q000209:etiology* / Q000382:microbiology; D014718:Vesico-Ureteral Reflux / Q000150:complications* / Q000000981:diagnostic imaging