title: Vesicoureteral reflux: an accurate predictor of acute pyelonephritis in childhood urinary tract infection?
abstract: 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.
authors.affiliation: Department of Radiology, Royal Childrens Hospital, Melbourne, Australia.
authors.forename: M R
authors.initials: MR
authors.lastname: Ditchfield
authors.forename: J F
authors.initials: JF
authors.lastname: De Campo
authors.forename: D J
authors.initials: DJ
authors.lastname: Cook
authors.forename: T M
authors.initials: TM
authors.lastname: Nolan
authors.forename: H R
authors.initials: HR
authors.lastname: Powell
authors.forename: R
authors.initials: R
authors.lastname: Sloane
authors.forename: K
authors.initials: K
authors.lastname: Grimwood
authors.forename: S
authors.initials: S
authors.lastname: Cahill
mesh_terms: 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