Comparison of the Clinical and Radiologic Characteristics between Different Age Groups with First Febrile UTI Under 2 Years of Age

Coe, Hee-Jung; Kim, Tae-Hyung; Cho, Hyuk; Kim, Ji-Hong

doi:2007.11.2.229

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

J Korean Soc Pediatr Nephrol 2007;11(2): 229-238. doi: https://doi.org/10.3339/jkspn.2007.11.2.229

2세 미만 소아의 첫 발열성 요로 감염에서 연령군에 따른 발병양상 및 영상의학적 검사 결과의 비교

고희정, 김태형, 조혁, 김지홍

¹연세대학교 의과대학 영동세브란스 소아과학교실 및 신질환 연구소
²연세대학교 의과대학 영동세브란스 소아과학교실 및 신질환 연구소
³연세대학교 의과대학 영동세브란스 소아과학교실 및 신질환 연구소
⁴연세대학교 의과대학 영동세브란스 소아과학교실 및 신질환 연구소

Comparison of the Clinical and Radiologic Characteristics between Different Age Groups with First Febrile UTI Under 2 Years of Age

Hee-Jung Coe, Tae-Hyung Kim, Hyuk Cho, Ji-Hong Kim

¹Department of Pediatrics, The Institut of Kidney Disease, Yong Dong Severance Hospital Yonsei University College of Medicine
²Department of Pediatrics, The Institut of Kidney Disease, Yong Dong Severance Hospital Yonsei University College of Medicine
³Department of Pediatrics, The Institut of Kidney Disease, Yong Dong Severance Hospital Yonsei University College of Medicine
⁴Department of Pediatrics, The Institut of Kidney Disease, Yong Dong Severance Hospital Yonsei University College of Medicine

ABSTRACT

Purpose : Since the first febrile UTI(urinary tract infection) in infants is commonly associated with vesicoureteral reflux(VUR), imaging studies such as renal ultrasonography, dimercaptosuccinic acid(DMSA) scan, and voiding cystourethrography(VCUG) are recommended. How-ever, because of the invasiveness of VCUG, it is difficult to perform in all young infants with febrile UTI. The purpose of this study is to compare the clinical and laboratory characteristics, radiologic findings between the young infant group(1 to 6month, n=121) and the old infant group(7 to 24months, n=91), and to determine the clinical and radiologic risk factors that predict the presence of VUR before the VCUG in patients with their first febrile UTI under 2 years of age.
Methods : We reviewed the medical records of 211 first febrile UTI patients under 2 years of age retrospectively, and compared clinical, laboratory, and radiologic findings between the two age groups.
Results : The young infant group had a male preponderance and a higher incidence of Escherichia coli in their urine culture. The incidence of acute renal parenchymal defects on DMSA scans were significantly increased in the young infant group. The incidence of VUR was 29% in patients who had a VCUG, but there were no differences in the incidence of VUR between the two age groups. Abnormal findings on DMSA scan significantly correlated with higher incidence of VUR in the young infant group. Incidence of abnormal findings DMSA scan significantly increased with high grade VUR(garde III-V ).
Conclusion : In treating first febrile UTI patients under 2 years, physicians have to consider such characteristics as age less than 6 months, male preponderance, E.coli in the urine culture, and increased incidence of abnormal findings on DMSA scans which correlated well with the presence of VUR. The results of the DMSA scan might help us to predict the presence of VUR before the VCUG in first febrile UTI and help us to reduce performing invasive radio-logic studies especially in the young infant group.

Key words: First febrile urinary tract infection | Vesicoureteral reflux | Young infant under 6 months