title: Prevalence and risk factors for renal scars in children with febrile UTI and/or VUR: a cross-sectional observational study of 565 consecutive patients.
abstract: OBJECTIVE
  To determine prevalence and risk factors for renal scar in children referred for urologic assessment of febrile UTI and/or VUR.
  
  
  METHODS
  Pre-determined risk factors for renal scar were prospectively recorded in consecutive patients referred for UTI/VUR. Age, gender, VUR grade, and reported number of febrile and non-febrile UTIs were analyzed with logistic regression to determine risk for focal cortical defects on non-acute DMSA.
  
  
  RESULTS
  Of 565 consecutive children, 24 (4%) had congenital renal dysplasia and 84 (15.5%) had focal defect(s). VUR, especially grades IV-V, recurrent febrile UTI, and older age increased risk. For any age child with the same number of UTIs, VUR increased odds of renal defect 5.4-fold (OR = 5.4, 95% CI = 2.7-10.6, AUC = 0.759).
  
  
  CONCLUSIONS
  Focal DMSA defects were present in 15.5% of 565 consecutive children referred for febrile UTI and/or VUR; 4% had presumed congenital reflux nephropathy without cortical defect. All VUR grades increased risk for these defects, as did recurrent febrile UTIs and older age. However, 43% with grades IV-V VUR and 76% with recurrent UTI had normal DMSA.
authors: Division of Pediatric Urology, Department of Urology, University of Texas Southwestern Medical Center, 2350 Stemmons Frwy, Suite D-4300, MC F4.04, Dallas, TX 75207, USA.
authors: Warren T
authors: WT
authors: Snodgrass
authors: Anjana
authors: A
authors: Shah
authors: Mary
authors: M
authors: Yang
authors: Jeannie
authors: J
authors: Kwon
authors: Carlos
authors: C
authors: Villanueva
authors: Janelle
authors: J
authors: Traylor
authors: Karen
authors: K
authors: Pritzker
authors: Paul A
authors: PA
authors: Nakonezny
authors: Robert W
authors: RW
authors: Haley
authors: Nicol Corbin
authors: NC
authors: Bush
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002921:Cicatrix / Q000000981:diagnostic imaging / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D005334:Fever / Q000000981:diagnostic imaging / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012008:Recurrence; D012307:Risk Factors; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D014552:Urinary Tract Infections / Q000000981:diagnostic imaging / Q000453:epidemiology*; D014718:Vesico-Ureteral Reflux / Q000000981:diagnostic imaging / Q000453:epidemiology*
chemical_list: D019275:Radiopharmaceuticals; D019783:Technetium Tc 99m Dimercaptosuccinic Acid
keywords: DMSA; Focal renal cortical defect; Renal scar; Technetium-99m dimercaptosuccinic acid renography; Urinary tract infection; Vesicoureteral reflux