Non-radiologic Methods for Predicting Vesicoureteral Reflux in Childhood Urinary Tract Infection

Jeon, Seong-Hoi; Lee, K.C.; Yoo, Kee-Hwan

J Korean Soc Pediatr Nephrol > Volume 1(1); 1997 > Article

J Korean Soc Pediatr Nephrol 1997;1(1): 38-45.

요로감염 환아에서 비방사선학적 방법에 의한 방광요관역류의 조기 예측에 관한 연구

전성회, 이광철, 유기환

¹고려대학교 의과대학 소아과학교실
²고려대학교 의과대학 소아과학교실
³고려대학교 의과대학 소아과학교실

Non-radiologic Methods for Predicting Vesicoureteral Reflux in Childhood Urinary Tract Infection

Seong-Hoi Jeon, K.C. Lee, Kee-Hwan Yoo

¹Department of Pediatrics, Korea University, College of Medicine
²Department of Pediatrics, Korea University, College of Medicine
³Department of Pediatrics, Korea University, College of Medicine

ABSTRACT

Purpose : Vesicoureteral reflux(VUR) in childhood may be the primary cause of recurrent urinary tract infection and renal scarring. Renal ultrasonography, DMSA, and voiding cystourethrogram are the standard clinical methods for detection of vesicoureteral reflux. But these methods have many disadvantages such as invasiveness and high cost. So, we studied to observe the significance of urine ${beta}_2$-microglobulin in association with other non-radiologic methods for predictng vesicoureteral reflux.
Methods : We evaluated 40 patients with urinary tract infection who were admitted to Korea university Hospital from July 1993 to June 1994. Among them, 24 patients revealed urinary tract infection and vesicoureteral reflux(group A), 16 patients revealed only urinary tract infection(group B). Both groups were compared by presence of fever, hematuria, and proteinuria, positivity of CRP, and level of BUN, Cr, GFR by 99mTc-DTPA, urine ${beta}_2$-microglobulin, 24 hours urine albumin.
Results : 1) Among 24 patients who had vesicoureteral reflux, 14 had unilateral VUR, 10 had bilateral VUR, three kidneys with grade I, nine with grade II, eleven with grade III, eleven with grade IV by classification of International Reflux Study Committee. Among them, 14 patients had renal scar, five with type A, five with type B, four with type C, none with type D by Smellie's classification. 2) The mean of GFR, BUN, Cr, 24hrs urine albumin and the presence of hematuria and proteinuria showed no significant difference between group A and group B. The mean of urine ${beta}_2$ microglobulin in group A and group B were $283.6{pm}195.8{mu}g/l$ and $78.7{pm}48.5{mu}g/l$ respectively, showing that group A had a higher value than group B (p<0.01). In case of ${beta}_2$ microglobulin > $120{mu}g/l$ and CRP(+), the sensitivity was 93.3% and the specificity is 77.8% for detecting of VUR. In case of ${beta}_2$-microglobulin>$120{mu}g/l$ and fever(+), the sensitivity was 92.2%, and the specificity was 62.5% for detecting of VUR
Conclusions : If the level of urinary ${beta}_2$-microglobulin is more than 120ug/l in children with urinary tract infection in association with fever(+) or CRP(+), it can predict VUR. So we can use it for early detection of VUR.

Key words: ${\beta}_2$-microglobulin | CRP | Fever | Vesicoureteral reflux