title: Ultrasonography and C-reactive protein can predict the outcomes of voiding cystography after the first urinary tract infection.
abstract: OBJECTIVE
  This study evaluated whether sex, clinical variables, laboratory variables or ultrasonography predicted the presence of vesicoureteric reflux during the first episode of urinary tract infection in paediatric patients. We also aimed to define the criteria that indicated the need for voiding cystography testing.
  
  
  METHODS
  We used voiding cystography to investigate 200 patients who experienced their first urinary tract infection at our institution between 2004 and 2013 and retrospectively analysed the data by reviewing their medical records.
  
  
  RESULTS
  Sex (p = 0.001), peak blood C-reactive protein levels (p < 0.001), the duration of fever after antibiotic administration (p = 0.007) and the ultrasonography findings grade (p < 0.001) were significantly different between patients with and without vesicoureteric reflux. Grade IV-V ultrasonography findings and C-reactive protein levels of ≥80 mg/L predicted vesicoureteric reflux with a sensitivity, specificity and odds ratio of 47.8%, 87.8% and 6.59 (95% confidence interval = 3.26-13.33), respectively (p < 0.001).
  
  
  CONCLUSIONS
  Voiding cystography should be performed for patients with C-reactive protein levels of ≥80 mg/L and grade IV-V ultrasonography findings, but is not necessary in patients with C-reactive protein levels of <80 mg/L and grade I-III ultrasonography findings.
authors.affiliation: Department of Pediatrics, Kumamoto Regional Medical Center, Kumamoto City, Kumamoto, Japan; Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto City, Kumamoto, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Kido
authors.forename: Fuminori
authors.initials: F
authors.lastname: Yoshida
authors.forename: Katsuya
authors.initials: K
authors.lastname: Sakaguchi
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Ueno
authors.forename: Masaaki
authors.initials: M
authors.lastname: Yanai
mesh_terms: D000293:Adolescent; D002097:C-Reactive Protein / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D014463:Ultrasonography; D019564:Unnecessary Procedures; D014552:Urinary Tract Infections / Q000097:blood / Q000000981:diagnostic imaging*
chemical_list: D002097:C-Reactive Protein
keywords: C-reactive protein; Ultrasonography; Urinary tract infection; Vesicoureteric reflux; Voiding cystography