The Decision of Voiding Cystourethrography in Children with Urinary Tract Infection

Kim, Dong-Woon; Choi, Eung-Sang; Lim, In-Seok

doi:2007.11.2.203

J Korean Soc Pediatr Nephrol > Volume 11(2); 2007 > Article

J Korean Soc Pediatr Nephrol 2007;11(2): 203-211. doi: https://doi.org/10.3339/jkspn.2007.11.2.203

소아 요로감염에서 배뇨성 방광 요도 조영술의 결정

김동운, 최응상, 임인석

¹중앙대학교 의과대학 소아과학교실
²중앙대학교 의과대학 소아과학교실
³중앙대학교 의과대학 소아과학교실

The Decision of Voiding Cystourethrography in Children with Urinary Tract Infection

Dong-Woon Kim, Eung-Sang Choi, In-Seok Lim

¹Department of Pediatrics, College of Medicine, Clung Ang University
²Department of Pediatrics, College of Medicine, Clung Ang University
³Department of Pediatrics, College of Medicine, Clung Ang University

ABSTRACT

Purpose : We attempted to compare the independent factors such as age, sex, C-reactive protein(CRP), and white blood cell count(WBC) in children with radiologic studies and assess the necessity of performing voiding cystourethrography(VCUG). Method : 98 children who have been diagnosed their first time febrile urinary tract infection from Janurary 2002 to Januray 2005 were enrolled. In all patient, the duration of fever which occurred before and after treatment was recorded, and CRP, WBC, $^{99m}Tc$-2,3-dimercaptosuccinic acid($^{99m}Tc$-DMSA) renal scans, renal ultrasound and VCUG were analyzed.
Results : Of the 98 children diagnosed with urinary tract infection(UTI), 52 were male and 46 were female. 18 had abnormalities in VCUG, 17 had abnormalities in kidney ultrasound, and 20 had partial defects or diffuse uptake decrease in $^{99m}Tc$-DMSA renal scans. There were no significant relationship between incidence of radiologic abnormalities and age. The risk of renal scar was significantly higher in children who had a longer febrile period before treatment than in those with shorter period. Both CRP and WBC were significantly elevated in children with the radiological abnormalities. A positive of $^{99m}Tc$-DMSA renal scans and renal ultrasound were highly associated with vesicoureteral reflux(VUR).
Conclusion : If there are abnormalities in the kidney ultrasound and $^{99m}Tc$-DMSA renal scan of a child with initial UTI, a VCUG is recommended. Even in cases without abnormal findings in $^{99m}Tc$-DMSA renal scan and renal ultrasound, clinical data such as CRP and WBC should be assessed, and VCUG should be Performed for the undetected VUR.

Key words: Urinary tract infection | Vesicoureteral reflux | Renal scar | $^{99m}Tc$-DMSA renal scan | Renal ultrasound