Practical approach to screen vesicoureteral reflux after a first urinary tract infection.
BACKGROUND
Vesicoureteral reflux (VUR) is a common pediatric urologic disorder. After the first urinary tract infection (UTI), imaging studies are recommended, starting with a renal ultrasound (RUS). Voiding cystourethrography (VCUG) and dimercaptosuccinic acid (DMSA) scan are the other main radiologic studies used to detect VUR. We evaluated the use of RUS as a screening method for VUR in children below 2 years of age, in order to avoid unnecessary VCUG.


METHODS
Medical records and imaging studies of infants (<2 years) who had their first UTI in a 6 year period were retrospectively reviewed. We evaluated the sensitivity, specificity, and negative predictive values of RUS and DMSA for diagnosing VUR.


RESULTS
Among 155 children (51% males) with their first UTI, 148 RUS were performed, 128 VCUG and 29 DMSA. VUR was detected in 21% patients; 14.5% low grade and 6.5% high grade. One hundred and twenty-one patients underwent both RUS and VCUG, 101 RUS were normal and 20 abnormal. Of the normal RUS 98% had no or low grade VUR. Among those with an abnormality on RUS 30% had high grade VUR (P < 0.001).


CONCLUSIONS
After the first UTI in infants (<2 years) RUS is a good screening method for VUR. Among such shildren with a normal RUS, we do not recommend VCUG or DMSA. In our opinion, VCUG should be performed only in patients with abnormal findings in RUS or in recurrent UTI.
Department of Pediatrics, Hospital Clínico San Carlos, Madrid, Spain.
María Álvarez
MÁ
Fuente
Department of Pediatrics, Hospital Clínico San Carlos, Madrid, Spain.
Talía Sainz
TS
Costa
Department of Pediatrics, Hospital Clínico San Carlos, Madrid, Spain.
Begoña Santiago
BS
García
Department of Pediatrics, Hospital Clínico San Carlos, Madrid, Spain.
Marcelina Algar
MA
Serrano
Department of Pediatrics, Hospital Clínico San Carlos, Madrid, Spain.
Manuel Sosa
MS
Alonso
Department of Pediatrics, Hospital Clínico San Carlos, Madrid, Spain.
Esther Aleo
EA
Luján
Dimercaptosuccinic acid scan; urinary tract infection; vesicoureteral reflux; voiding cystourethrography