Korean J Urol.  2014 Aug;55(8):536-541. 10.4111/kju.2014.55.8.536.

Are Clinical, Laboratory, and Imaging Markers Suitable Predictors of Vesicoureteral Reflux in Children With Their First Febrile Urinary Tract Infection?

• Mahyar A
• Ayazi P
• Mavadati S
• Oveisi S
• Habibi M
• Esmaeily S

• KMID: 1794589
• DOI: http://doi.org/10.4111/kju.2014.55.8.536

Abstract

PURPOSE
This study was conducted to determine the predictive value of clinical, laboratory, and imaging variables for the diagnosis of vesicoureteral reflux in children with their first febrile urinary tract infection.
MATERIALS AND METHODS
One hundred fifty-three children with their first febrile urinary tract infection were divided into two groups according to the results of voiding cystourethrography: 60 children with vesicoureteral reflux and 93 children without. The sensitivity, specificity, positive and negative predictive value, likelihood ratio (positive and negative), and accuracy of the clinical, laboratory, and imaging variables for the diagnosis of vesicoureteral reflux were determined.
RESULTS
Of the 153 children with febrile urinary tract infection, 60 patients (39.2%) had vesicoureteral reflux. There were significant differences between the two groups regarding fever>38degrees C, suprapubic pain, C-reactive protein quantitative level, number of red blood cells in the urine, and results of renal ultrasound and dimercaptosuccinic acid renal scanning (p<0.05). There were significant positive correlations between fever>38.2degrees C and dimercaptosuccinic acid renal scanning and vesicoureteral reflux. Also, there were significant positive correlations between the erythrocyte sedimentation rate, positive urinary nitrite test, hyaline cast, and renal ultrasound and high-grade vesicoureteral reflux.
CONCLUSIONS
This study revealed fever>38.2degrees C and dimercaptosuccinic acid renal scanning as the best predictive markers for vesicoureteral reflux in children with their first febrile urinary tract infection. In addition, erythrocyte sedimentation rate, positive urinary nitrite test, hyaline cast, and renal ultrasound are the best predictive markers for high-grade vesicoureteral reflux.

Keyword

99mTc-Dimercaptosuccinic acid scan; Sedimentation rate; Urinary tract infections; Vesicoureteral reflux

MeSH Terms

Biological Markers/metabolism
Blood Sedimentation
C-Reactive Protein/metabolism
Child
Child, Preschool
Cross-Sectional Studies
Female
Fever/etiology
Humans
Infant
Kidney/radionuclide imaging/ultrasonography
Male
Predictive Value of Tests
Radiopharmaceuticals/diagnostic use
Sensitivity and Specificity
Technetium Tc 99m Dimercaptosuccinic Acid/diagnostic use
Urinary Tract Infections/*etiology
Vesico-Ureteral Reflux/*complications/*diagnosis
Biological Markers
C-Reactive Protein
Radiopharmaceuticals
Technetium Tc 99m Dimercaptosuccinic Acid

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