title: Place of ultrasonography in predicting vesicoureteral reflux in patients with mild renal scarring.
abstract: OBJECTIVE
  To evaluate the role of renal ultrasonography (USG) in predicting vesicoureteral reflux (VUR) in children with mild renal scarring determined by dimercaptosuccinic acid scintigraphy performed after attack of urinary tract infections (UTI).
  
  
  METHODS
  Dimercaptosuccinic acid scintigraphy, voiding cystourethrography (VCUG), and renal USG findings were evaluated retrospectively in children with UTI. Each kidney was evaluated as a separate renal unit (RU). RUs with severe scarring were excluded from the study. RUs having mild scarring with and without abnormal USG findings (group 1 and group 2, respectively) were compared in terms of the presence of VUR.
  
  
  RESULTS
  There were a total of 228 patients (70 men, mean age 47.06 ± 44.14 months) and 456 RUs. Of the 185 RUs with mild scarring, 55 had abnormal USG findings (group 1), whereas 130 had normal USG findings (group 2). The rates of VUR and severe VUR (≥grade 4) were higher in group 1 compared with group 2 (69% vs 43%, P = .001 and 35% vs 7% respectively, P <.001). The sensitivity, specificity, positive predictive value, negative predictive value, and odds ratio of USG findings in predicting VUR in RU with mild scarring were 68%, 80%, 38%, 93%, and 8.2, respectively.
  
  
  CONCLUSIONS
  Normal renal USG findings exclude a diagnosis of high-grade VUR to a large extend in children with UTI and mild renal scarring. Refraining from invasive VCUG might be a reasonable approach in these patients provided that no other predisposing factors for UTI and/or renal scarring present.
authors: Department of Pediatric Nephrology, Dokuz Eylul University, Faculty of Medicine, İzmir, Turkey. Electronic address: meralt.bayram@yahoo.com.tr.
authors: Meral Torun
authors: MT
authors: Bayram
authors: Department of Pediatric Nephrology, Dokuz Eylul University, Faculty of Medicine, İzmir, Turkey.
authors: Salih
authors: S
authors: Kavukcu
authors: Department of Pediatric Nephrology, Dokuz Eylul University, Faculty of Medicine, İzmir, Turkey.
authors: Demet
authors: D
authors: Alaygut
authors: Department of Pediatric Nephrology, Dokuz Eylul University, Faculty of Medicine, İzmir, Turkey.
authors: Alper
authors: A
authors: Soylu
authors: Department of Radiology, Dokuz Eylul University, Faculty of Medicine, İzmir, Turkey.
authors: Handan
authors: H
authors: Cakmakcı
mesh_terms: D002648:Child; D002675:Child, Preschool; D002921:Cicatrix / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D005334:Fever; D006801:Humans; D007223:Infant; D007668:Kidney / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D011704:Pyelonephritis / Q000150:complications / Q000000981:diagnostic imaging; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D004113:Succimer / Q000737:chemistry; D014463:Ultrasonography; D014552:Urinary Tract Infections / Q000150:complications / Q000000981:diagnostic imaging*; D014718:Vesico-Ureteral Reflux / Q000150:complications* / Q000000981:diagnostic imaging*
chemical_list: D004113:Succimer