Diagnostic Performance of Renal Ultrasound to Detect Vesicoureteral Reflux in Children with First Febrile UTI

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มนัสจิตต์ บุณยทรรพ


Background: Urinary tract infection (UTI) is a common febrile infectious disease in children. Vesicoureteral reflux (VUR) is the major predisposing factor for UTI and investigation of choice is voiding cystourethrogram (VCUG). The 2014 Thai Pediatric Nephrology Association guidelines state that VCUG is indicated for patients with abnormal renal bladder and ultrasound (RBUS), recurrent UTI or unusual presentations. The implicit assumption that normal RBUS effectively
rules out VUR is still questionable.
Objective: To assess the diagnostic performance of RBUS for detecting VCUG in children hospitalized with first febrile UTI.
Material and method: Children aged 0-15 years who had been hospitalized with first episode of febrile UTI in Lampang Hospital between June 2009-June 2014 were retrospectively reviewed. All of them underwent both RBUS within 3 days of admission and VCUG within 2 weeks after discharge. Patients with previous genitourinary anomaly or neurogenic bladder were excluded. Sensitivity, specificity, and predictive values of RBUS for VCUG abnormalities were determined.
Results: Of 160 children included in the study, eighty-nine were male (55.6%). The mean age was 8.0 ± 6.0 months (range, 0.1-24.1) and mostly between 2-24 months (148 cases, 92.5%). Thirteen children had abnormal RBUS suggesting VUR, of whom only eight had VUR on VCUG. VUR was found in 21 children, among these 13 cases had normal RBUS. The sensitivity, specificity, positive and negative predictive value of abnormal RBUS for detecting VUR were
38.1%, 96.4%, 61.5% and 91.2% respectively.
Conclusion: RBUS yielded high specificity but low sensitivity to detect VUR in the first episode of childhood UTI. RBUS and VCUG should be used complementary as they provide different essential information.

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บุณยทรรพ ม. (2015). Diagnostic Performance of Renal Ultrasound to Detect Vesicoureteral Reflux in Children with First Febrile UTI. Lampang Medical Journal, 36(2), 74–83. Retrieved from https://he01.tci-thaijo.org/index.php/LMJ/article/view/186401
Original Article


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