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Journal of the Korean Society of Pediatric Nephrology 2008;12(1): 62-69. doi: https://doi.org/10.3339/jkspn.2008.12.1.62
요로감염 환아에서 방광요관 역류를 예측할 수 있는 인자에 대한 연구
이승현, 노성훈, 오정은, 김민선, 이대열
1전북대학교 의학전문대학원 소아과학교실
2전북대학교 의학전문대학원 소아과학교실
3전북대학교 의학전문대학원 소아과학교실
4전북대학교 의학전문대학원 소아과학교실
5전북대학교 의학전문대학원 소아과학교실
Predictive Value for Vesicoureteral Reflux in Children with Urinary Tract Infection
Seung-Hyun Lee, Sung-Hoon Noh, Jeung-Eun Oh, Min-Sun Kim, Dae-Yeol Lee
1Department of Pediatrics, Chonbuk National University Medical School
2Department of Pediatrics, Chonbuk National University Medical School
3Department of Pediatrics, Chonbuk National University Medical School
4Department of Pediatrics, Chonbuk National University Medical School
5Department of Pediatrics, Chonbuk National University Medical School
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ABSTRACT
Purpose: The most concerning issue in children with urinary tract infection(UTI) is the probability of underlying genitourinary anomalies and vesicoureteral reflux (VUR), which is frequently associated with renal scarring and eventually end-stage renal disease. Therefore, voiding cystourethrography(VCUG) is usually recommended at the earliest convenient time for children with UTI. However, VCUG is an invasive procedure that requires catheterization and exposure to X-ray. In this study, we aimed to determine the predictability of clinical, laboratory and imaging parameters for VUR in children with UTI.
Methods: Data of children with bacteriologically proven UTI who underwent VCUG were evaluated retrospectively for clinical(age, gender, fever), laboratory(leukocytosis, ESR, CRP, pyuria, blood urea nitrogen, serum creatinine) and imaging(renal ultrasound and DMSA renal scan) findings. First, children with UTI were divided into two groups according to the presence of VUR as non-VUR group and with VUR group, and clinical, laboratory variables were compared between these groups. Second, patients who had VUR were reclassified as low-grade VUR(grade I-II) group and high-grade(grade III-V) VUR group according to grading of VUR, and clinical, laboratory and imaging variables were compared between these groups.
Results : Among 410 children with UTI, 137 had VUR and 78 high-grade VUR. Fever, leukocytosis, ESR, CRP, pyuria were associated with VUR. In addition, abnormal findings of ultrasonography and DMSA renal scan were closely related to VUR. However, these clinical and laboratory variable in patients with high grade VUR were not different significantly, compared to those with low-grade VUR group.
Conclusion : Fever, leukocytosis, ESR, CRP seems to be potentially useful predictors of VUR in pediatric patients with UTI. In addition, renal ultrasonography and DMSA renal scan findings supported the presence of VUR. Further study of these findings could limit unnecessary VCUG in patients with UTI.
Key words: Vesicoureteral reflux | Voiding cystourethrography | UTI
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