Korean J Pediatr.  2010 Feb;53(2):222-227. 10.3345/kjp.2010.53.2.222.

The relationships between clinical variables and renal parenchymal disease in pediatric clinically suspected urinary tract infection

• Byun JL
• Lee ST
• Chung S
• Kim KS

• KMID: 2281370
• DOI: http://doi.org/10.3345/kjp.2010.53.2.222

Abstract

PURPOSE
To evaluate the significance of clinical signs and laboratory findings as predictors of renal parenchymal lesions and vesicoureteral reflux (VUR) in childhood urinary tract infection (UTI).
METHODS
From July 2005 to July 2008, 180 patients admitted with a first febrile UTI at the Pediatric Department of Konkuk University Hospital were included in this study. The following were the clinical variables: leukocytosis, elevated C-reactive protein (CRP), positive urine nitrite, positive urine culture, and fever duration both before and after treatment. We evaluated the relationships between clinical variables and dimercaptosuccinic acid (DMSA) scan and voiding cystourethrography (VCUG) results.
RESULTS
VCUG was performed in 148 patients; of them, 37 (25.0%) had VUR: 18 (12.2%) had low-grade (I-II) VUR, and 19 (10.5%) had high-grade (III-V) VUR. Of the 95 patients who underwent DMSA scanning, 29 (30.5%) had cortical defects, of which 21 (63.6%) had VUR: 10 (30.3%), low-grade (I-II) VUR; and 11 (33.3%), high-grade VUR. Of the 57 patients who were normal on DMSA scan, 8 (14.0%) had low-grade VUR and 6 (10.5%) had high-grade VUR. The sensitivity, specificity, and positive and negative predictive values of the DMSA scan in predicting high-grade VUR were 64.7%, 69.9%, 33.3%, and 89.5%, respectively. Leukocytosis, elevated CRP, and prolonged fever (> or =36 hours) after treatment were significantly correlated with the cortical defects on DMSA scans and high-grade VUR.
CONCLUSION
Clinical signs, including prolonged fever after treatment, elevated CRP, and leukocytosis, are positive predictors of acute pyelonephritis and high-grade VUR.

Keyword

Urinary tract infection; Vesicoureteral reflux; Tc-99m Dimercaptosuccinic acid; Child

MeSH Terms

C-Reactive Protein
Child
Fever
Humans
Leukocytosis
Pyelonephritis
Sensitivity and Specificity
Succimer
Technetium Tc 99m Dimercaptosuccinic Acid
Urinary Tract
Urinary Tract Infections
Vesico-Ureteral Reflux
C-Reactive Protein
Succimer
Technetium Tc 99m Dimercaptosuccinic Acid