title: Diagnosis of vesicoureteral reflux according to the 1999 and 2011 guidelines of the Subcommittee on Urinary Tract Infection of the American Academy of Pediatrics.
abstract: In 1999, the American Academy of Pediatrics (AAP) recommended perform a renal ultrasonography and avoiding cystourethrography to all infants between 2 and 24 months of age after their first urinary tract infection (UTI). In 2011, the AAP restricted voiding cystourethrography to children with a pathological ultrasonography, recurrent and/ or atypical infections. Our objective was to compare, in patients with vesicoureteral reflux (VUR) and normal renal ultrasonography, the prevalence of a relevant pathology as if patients had been studied as per the 1999 guidelines (for first UTI) or the 2011 guidelines (for recurrent and/or atypical UTI).
  
  
  
  We conducted a retrospective analysis of patients with UTI, aged between 2 and 24 months old, seen at our department between January 2010 and August 2014 and who had a normal renal ultrasonography and VUR. A relevant pathology was defined as a finding of grade III VUR or higher and/or pathological renal scintigraphy.
  
  
  
  Forty-five patients (31 girls) were included and were grouped as if they had been treated as per the 1999 or 2011 guidelines. The prevalence of a relevant pathology among patients studied as per the 1999 guidelines (9 out of 24 cases, 3 with atypical UTI) or as per the 2011 guidelines (11 out of 21 cases) was similar (37.5% versus 52%, respectively; p= 0.31). Six patients (25%) with a relevant pathology diagnosed as per the 1999 guidelines would not have been identified in a timely manner with the 2011 version.
  
  
  
  The prevalence of a relevant pathology identified in children with VUR and normal renal ultrasonography was similar with both guidelines. However, considering the present guidelines, one out of four patients would have been exposed to a delayed or potentially missed diagnosis if recurrence would have been expected to complete the assessment.
authors.affiliation: Unidad de Nefrología, Hospital General de Niños "Pedro de Elizalde", Ciudad Autónoma de Buenos Aires, C1270AAN, Argentina. marcapone77@yahoo.com.ar.
authors.forename: Marina A
authors.initials: MA
authors.lastname: Capone
authors.affiliation: Unidad de Nefrología, Hospital General de Niños "Pedro de Elizalde", Ciudad Autónoma de Buenos Aires, C1270AAN, Argentina.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Balestracci
authors.affiliation: Unidad de Nefrología, Hospital General de Niños "Pedro de Elizalde", Ciudad Autónoma de Buenos Aires, C1270AAN, Argentina.
authors.forename: Ismael
authors.initials: I
authors.lastname: Toledo
authors.affiliation: Unidad de Nefrología, Hospital General de Niños "Pedro de Elizalde", Ciudad Autónoma de Buenos Aires, C1270AAN, Argentina.
authors.forename: Sandra M
authors.initials: SM
authors.lastname: Martin
mesh_terms: D005260:Female; D006801:Humans; D007223:Infant; D007668:Kidney / Q000000981:diagnostic imaging*; D008297:Male; D010372:Pediatrics; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D014481:United States; D014552:Urinary Tract Infections / Q000175:diagnosis; D014718:Vesico-Ureteral Reflux / Q000000981:diagnostic imaging*
keywords: American Academy of Pediatrics; Diagnosis; Guideline; Urinary tract infection; Vesicoureteral reflux