Prediction of High Grade Vesicoureteral Reflux in Infants Less than 3 Months with Urinary Tract Infection

Yi, Dae-Yong; Kim, Na-Yeon; Cho, Hee-Yeon; Kim, Ji-Eun; Sim, So-Yeon; Son, Dong-Woo; Jeon, In-Sang; Cha, Han

doi:2008.12.2.178

J Korean Soc Pediatr Nephrol > Volume 12(2); 2008 > Article

J Korean Soc Pediatr Nephrol 2008;12(2): 178-185. doi: https://doi.org/10.3339/jkspn.2008.12.2.178

3개월 미만 요로감염 영아에서 중증 방광 요관 역류의 예측인자

이대용, 김나연, 조희연, 김지은, 심소연, 손동우, 전인상, 차한

¹가천의과학대학교 소아청소년과학교실
²가천의과학대학교 소아청소년과학교실
³가천의과학대학교 소아청소년과학교실
⁴가천의과학대학교 영상의학과교실
⁵가천의과학대학교 소아청소년과학교실
⁶가천의과학대학교 소아청소년과학교실
⁷가천의과학대학교 소아청소년과학교실
⁸가천의과학대학교 소아청소년과학교실

Prediction of High Grade Vesicoureteral Reflux in Infants Less than 3 Months with Urinary Tract Infection

Dae-Yong Yi, Na-Yeon Kim, Hee-Yeon Cho, Ji-Eun Kim, So-Yeon Sim, Dong-Woo Son, In-Sang Jeon, Han Cha

¹Department of Pediatrics, Gachon University of Medicine and Science
²Department of Pediatrics, Gachon University of Medicine and Science
³Department of Pediatrics, Gachon University of Medicine and Science
⁴Department of Radiology, Gachon University of Medicine and Science
⁵Department of Pediatrics, Gachon University of Medicine and Science
⁶Department of Pediatrics, Gachon University of Medicine and Science
⁷Department of Pediatrics, Gachon University of Medicine and Science
⁸Department of Pediatrics, Gachon University of Medicine and Science

ABSTRACT

Purpose : Our aim was to investigate the predictive factors for detecting grade III-V vesicoureteral reflux(VUR) in young infants less than 3 months with urinary tract infections (UTI).
Methods : Data of infants who underwent ultrasonography and VCUG between January 2004 and September 2007 were reviewed. Age, gender, incidence of bacteremia, C-reactive protein(CRP) and imaging studies were compared between group I(grade III-V VUR) and group II (normal or grade I and II VUR) retrospectively. Sensitivity, specificity, positive and negative predictive values, odds ratio, and likelihood ratio of ultrasonography for high grade VUR were evaluated.
Results : Among 54 enrolled infants(41 males, 13 females), 14 infants were group I and 40 infants were group II. In the group I, CRP level was significantly higher(6.11$pm$5.18 vs. 3.27$pm$3.45, P=0.025), and there were more ultrasonographic abnormal findings(71.4%, vs. 22.5%, P=0.002) compared with group II. However, ultrasonography was the only significant factor after adjusting with logistic regression(P=0.002). Incidence of bacteremia and abnormal DMSA findings were not significantly different in two groups. Sensitivity, specificity, and odds ratio of ultrasonography was 71.4%, 77.5%, 6.9 respectively. Negative predictive value was 88.6% and negative likelihood ratio was 0.37. Ultrasonography had significant negative likelihood ratio for grade III-V VUR, but missed 4 infants with grade III VUR.
Conclusion : We could not find any alternative predictive factors to reduce VCUG in detecting high grade VUR. Therefore, VCUG must be considered in young infants less than 3 months with UTI.

Key words: Urinary tract infection | Vesicoureteral reflux | Ultrasonography