Renal Scarring in Children with Primary Vesicoureteral Reflux Disease

Aims:To determine the incidence of renal scarring among patients with primary vesicoureteral reflux (VUR) and the possible risk factor(s), we studied 69 children (42 girls and 27boys) with VUR attending the Pediatric opd.Study Design:Prospective Observational study.Place and duration of Study:Department of pediatrics,Sher I Kashmir Institute of Medical Sciences,Srinagar, Kashmir between June 2017 to June 2018.Methodology:All the patients were assessed for VUR grade by voiding cystoureterography and for presence of renal scarring by (99 m) technetium dimercapto–succinic acid scintigraphy. Results:Grade of reflux and number of urinary tract infection (UTI) episodes (≥3) were found to be statistically significant risk factors for renal scarring (P <0.05). However,there was no significant association with gender,familial history and laterality of the disease (P >0.05). Similarly, there was no statistically significant difference of frequency of renal scarring among the different age groups (P >0.05).Conclusions:It was concluded that recurrences of UTI and VUR severity are significant risk factors for renal scarring in children with VUR. Therefore,identification of VUR at an early age may offer the opportunity to prevent episodes of UTI and possible formation of renal scars that may result in end-stage renal failure

Paediatric Urinary Tract Infection: Microbiologic Profile and Antibiotics Sensitivity in Children Presenting with UTI

Background: This study was designed to determine the microbiologic profile and Antibiotics Sensitivity in Children presenting with UTI. Materials & Methods: This hospital based prospective study was conducted in 28 patients Patients from 2 months to 12 years were admitted to the pediatric ward and visited in outpatient department (OPD) with diagnosis of UTI based on history with routine and microscopic examination of urine were considered for this study. The UTI investigation protocol recommended ultrasound, voiding cystourethrography (VCUG), and DMSA scan. Clinical and laboratory parameters at the index infection, including highest measured temperature, highest C-reactive protein (CRP), bacterial findings, and the number of febrile recurrences, were recorded. Results: Fever was the most common symptom accounting for 76.4% of patients with nausea and vomiting (42.8%), dysuria (53.6%), abdominal pain (57.1%) and anorexia (46.4%). Urine analysis was done in all suspected cases of UTI. Among all urine samples 60.7% had WBC >10/hpf, followed by 87 (28.6%) which had WBC between 6-10/hpf. Only 6 (10.7%) had WBC 5 or less. Among all urine analyses 68 (57.1%) Conclusion: E. coli (82%) was the most common organism found followed by Klebsiella pneumonia (12%), Proteus mirabilis (5%)and 1% were other pathogens like Enterococcus species (Table 4, Fig 1). All isolated E. coli was sensitive to Imipenem, Nalidixic acid, Netilmicin and Vancomycin. E. coli were 80-90% sensitive to Amikacin, Ceftriaxone, Cefuroxime, Ofloxacin, Gentamicin and Nitrofurantoin.

Renal cortical scan as the first investigation in identifying children at risk for vesicoureteral reflux and renal defects: A 10-year retrospective review of DMSA and VCUG imaging in patients with first febrile urinary tract infection

The objective of the study is to determine the accuracy of renal cortical scan in detection of vesicoureteral reflux (VUR) in children five years old and below diagnosed with urinary tract infection and to determine if Renal cortical scan can predict the prevalence of VUR in children and screening those who will need voiding cystourethrography (VCUG).METHODS: The medical records of 302 patients who presented with a first febrile urinary tract infection and underwent VCUG and renal cortical scan during a 10-year period starting from 2000 to 2010 were reviewed retrospectively. Patients with systemic diseases other than acute pyelonephritis/VUR and those with other concomitant anatomic or neurological abnormalities were dropped from the study. Included participants were then grouped according to age range; 1 day to 1 month, 1 to 12 months, 13 to 24 months, and 2 to 5 years.RESULTS: The study consisted of 302 patients and 604 renal units. Males were 45.3% and females were 54.6% of the population. Computed odds ratio and relative risk associated with positive VUR and renal cortical scan using dimercaptosuccinic acid (DMSA) was at 4.15 [Cl 2.93-5.908] and 2.398 [Cl 1.924-2.989] respectively. This suggests that patients with positive Renal cortical scans are 4.15 times more likely to have VUR, or conversely, the risk of developing VUR with a positive renal cortical scan is approximately 2.398 times than if DMSA results were negative. Renal cortical scan has been found to be 96.6% sensitive in detecting VUR among patients with the condition and is 89.82% specific in detecting the absence of VUR among normal individuals [PPV 55.8% and NPV 76.7%].CONCLUSION: Renal cortical scan could be used a first line imaging investigation tool for determining high grade VUR. VCUG may not be necessary in all young children with first febrile UTI when the renal cortical scan is negative. VCUG could be warranted only foe those children with positive results on renal cortical scan.

Clinical examination comparison of under 2 years old patients with and without vesicoureteral reflux / 中华实用儿科临床杂志

Objective To provide some evidence for choosing the strategy for conducting micturating cystourethrography(MCU) examination in infants under 2 years old with urinary tract infection(UTI) by comparing the clinical examinations in patients under 2 years old with and without vesicoureteral reflux.Methods One hundred and twelve inpatients from Yuying Children's Hospital,Wenzhou Medical University,under 2 years old with UTI from Jan.2009 to Dec.2011 were collected,The incidence of vesicoureteral reflux(VUR) among 3 groups(＜ 6 months old,6 months to 1 year old and 1 to 2 years old) was analyzed and the differences in body temperature,white blood cell,C-reacting protein (CRP),urinary β2-microglobulin (β2-MG),urine N-acety1 glucosaminidase (NAG),ultrasound examination (USG)anomaly and dimercaptosuccinic acid (DMSA) anomaly between VUR positive and negative patients were compared.Results The detection rate of VUR and the grade of regurgitation were not statistically different in each age group of infants under 2 years old with UTI.There were 10 cases with urine β2-MG increasing in VUR positive group,significantly higher than those in the VUR negative group(6 cases) (P ＜0.01),but there was no difference in others.Conclusions The urine β2-MG increasing is the intense indication for performing MCU in infant under 2 years old with UTI,and the possibility of VUR in these patients even without fever should also be vigilant.

Fibrossarcoma uretral primário em cadela / Primary urethral fibrosarcoma in a female dog

Relatou-se um caso de fibrossarcoma localizado na uretra média de uma cadela, sem raça definida, que apresentava sinais de polaquiúria, estrangúria e hematúria no início da micção. O animal também apresentava poliúria, polidipsia, êmese e anorexia há dois dias. Os exames complementares levaram ao diagnóstico de hidronefrose bilateral, hipoplasia renal direita e massa em uretra causando dilatação dorsal de sua porção média. A biópsia não foi realizada antemortem devido ao estado geral do paciente, que, mesmo com a instituição de tratamento para doença renal crônica, não apresentou progresso. A uretrocistografia retrógrada e a histologia foram os exames decisivos para detectar o fibrossarcoma uretral. A ultrassonografia e a citologia por sondagem traumática não foram conclusivos, devido ao fato de a massa apresentar-se em região media de uretra e o caráter pouco esfoliativo da neoplasia.

A case of fibrosarcoma located at medium portion of the urethra of a female dog which presented pollakiuria, estranguria and hematuria at the beginning of urination was reported. The patient also presented polyuria, polydipsia, emesis and anorexia for two days. The complementary exams lead to the diagnosis of bilateral hydronephrosis, right renal hypoplasy and a mass in the urethra causing a dorsal dilatation at its medium portion. A biopsy was not performed antemortem because the general condition of the patient, which even with the institution of treatment for chronic kidney disease, showed no progress. The retrograde cystourethrography and histopathology examinations were decisive to detect urethral fibrosarcoma. Ultrasonography and cytology through traumatic probe were inconclusive, due to the mass location and its exfoliating properties.

Echocontrast cystosonography versus micturating cystourethrography in the detection of vesicoureteric reflux

Purpose: To compare echocontrast cystosonography (ECS) using in-vivo agitated saline with fluoroscopic micturating cystourethrography (MCU) in the detection and grading of vesicoureteric reflux (VUR). Materials and methods: This was a prospective study of 25 children, who had MCU between 2007 and 2009. ECS was performed and findings documented prior to MCU. Baseline renal and bladder sonograms were obtained. The bladder was filled with normal saline followed by introduction of 10–20 mls of air to generate microbubbles. Detection of VUR was based on two sonographic criteria: (1) presence of microbubbles in the pelvicaliceal system (PCS), and (2) increase in dilatation of the PCS. VUR was graded as (1) Grade I: microbubbles seen in ureter only; (2) Grade II: microbubbles seen in non-dilated PCS; and (3) Grade III-V: microbubbles seen in dilated PCS. The ECS findings were compared using MCU as the gold standard. Results: Of the 50 kidney-ureter (K-U) units studied, ECS detected 9 of 10 K-U units with VUR on MCU. ECS did not detect a Grade II VUR. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value for criterion 1 was 90%, 87.5%, 88%, 64.3% and 97%, respectively, compared to criterion 2 which was 70%, 90%, 86%, 64% and 92%, respectively. The grading of VUR was similar on both ECS and MCU except for one case. Conclusion: ECS using agitated saline was a sensitive technique for the detection of VUR. ECS grading was comparable with MCU grading of VUR.

Prevalence of Vesicoureteral Reflux According to the Timing of Voiding Cystourethrography in Infantile Urinary Tract Infection

PURPOSE: To evaluate the prevalence of vesicoureteral reflux (VUR) according to the timing of voiding cystourethrography (VCUG) in infantile urinary tract infection (UTI). METHODS: The data of 134 infants (1-12 months) with renal cortical defect in 99mTc-2, 3-dimercaptosuccinic acid (99mTc-DMSA) scan with a diagnosis of UTI in two hospitals from 2000 to 2010 were retrospectively analyzed. The VCUG was performed after 2 weeks from the diagnosis of UTI in Group I (n=68), and the VCUG was performed within 2 weeks from the diagnosis of UTI in Group II (n=66). RESULTS: There were no significant differences between the two groups in the duration of fever, white blood cell count, C-reactive protein levels, and abnormalities in ultrasonography (P>0.05). There was no significant difference between the two groups in the prevelence of VUR, bilateral VUR, and severe VUR. VCUG-induced UTI was detected 16 (23.5%) of patients in whom the procedure was performed 2 weeks after the diagnosis, and none of VCUG-induced UTI occurred in those in whom the procedure was performed 2 weeks within the diagnosis. CONCLUSION: We conclude that the prevalence of VUR according to the timing of VCUG did not differ between the two groups in infantile UTI with renal cortical defect in DMSA scan. We also found that performing VCUG with antibiotics can decrease risk of VCUG-induced UTI.

Difference of Anxiety of Parents: before & after the VCUG

PURPOSE: The voiding cystourethrogram (VCUG) is the investigation of choice in detecting the vesicoureteral reflux in urinary tract infections in children. As it is a potentially distressing and invasive test, most of the parents are so concerned about the child's stress. In this study, we compared the difference of the state of anxiety of parents before and after the VCUG. METHODS: We divided 68 parents whose children underwent VCUG into 2 groups; who have given an explanation about VCUG in detail using pictures (group 1) Vs. who have given an oral explanation only (group 2). All the parents submitted the same questionnaire 2 times before and after the VCUG, which consisted of State-Trait-Anxiety-Inventory X-I (STAI-X-I) and visual analog scale (VAS) on the perception of worry, anxiety, confusion and pain. RESULTS: Before VCUG, the perception of pain was higher in group 1 (P < 0.05). After VCUG, the anxiety and confusion were significantly higher in group 2 than group 1 (P < 0.05). In group 1, STAI-X-I scores, the perception of worry and anxiety were significantly decreased after the VCUG (P < 0.05). In group 2, the confusion and pain were increased after VCUG (P < 0.05). CONCLUSION: It showed that doctor's explanation on the procedure in advance may raise the perception of pain and the possibility of refusal by parents. But the STAI-X-I, worry, anxiety after VCUG were significantly decreased in group 1, while the confusion and pain were increased in group 2. Therefore we suggest that prior and sufficient explanation about invasive procedure like VCUG can be helpful in ameliorating the anxiety of the parents.

Reflujo vesicoureteral asociado a dilatación del tracto urinario fetal / Vesicoureteral reflux associated with dilation of fetal urinary tract

El objetivo del presente estudio fue presentar los porcentajes de reflujo vesicoureteral encontrados en niños a los cuales se detectó dilatación del tracto urinario superior durante el período fetal, en el seguimiento de un embarazo normal. MÉTODOS. En los niños con dilatación grave o moderada, confirmada después del nacimiento, se realizó uretrocistografía miccional para precisar la existencia de reflujo vesicoureteral como causa de la dilatación prenatal. Cuando no se pudo medir la pelvis en los ultrasonidos prenatales y sólo se informó ½ dilatación, se hizo el estudio atendiendo a los resultados del primer ultrasonido renal. En las dilataciones ligeras sólo se realizó uretrocistografía miccional si el niño se infectó, si la dilatación progresó o si existían síntomas asociados que indicaban una probable obstrucción urinaria baja. En las dilataciones bilaterales se estudiaron unidades renales con dilatación ligera, si en el riñón contralateral la dilatación era de mayor grado. RESULTADOS. Entre enero de 2002 y diciembre de 2007 fueron remitidos a la Consulta de Nefrología 119 niños a los que, mediante el seguimiento ultrasonográfico de un embarazo normal, se les había detectado una anomalía dilatante del tracto urinario. Diez niños abandonaron el seguimiento antes de que se precisara el diagnóstico y 109 fueron estudiados. En los 119 niños remitidos se encontraron 187 unidades dilatadas, ya que 78 tenían dilatación bilateral prenatal. De los 109 estudiados, 69 fueron varones con 118 unidades renales dilatadas y 40, niñas con dilatación en 69 unidades. Se encontró reflujo vesicoureteral en 22 pacientes (20,1 por ciento) y 33 unidades refluyentes, pues en 11 niños el reflujo era bilateral. Predominó el reflujo de alto grado (IV y V). CONCLUSIÓN. Entre las dilataciones del tracto urinario que se pesquisan en el período prenatal es necesario buscar un posible reflujo vesicoureteral, el cual està presente en el 20 % de los casos...

The aim of present study was to shows percentages of vesicoureteral reflux found in children presenting with dilation of upper urinary tract during fetal period in follow-up of normal a pregnancy. METHODS: In children with a severe o moderate dilation, confirmed after birth, we carried out a micturition urethra-cystography to set existence of vesicoureteral reflux as cause of prenatal dilation. When it was impossible to measure pelvis in prenatal USs, and only dilation reported, we made study considering results of first renal US. In slight dilations a micturition cystoureterogram if the child was infected, if dilation progressed or if there were associated symptoms signaling a probable lower urinary obstruction. In case of bilateral dilations we studied kidney units with slight dilations, if in contralateral kidney dilation was of a greater degree. RESULTS: Between January 2002 and December 2007, 119 children were referred to Nephrology consulting room in which by means of a ultrasonic follow-up of normal pregnancy, it was detected an expansive anomaly of urinary tract. Ten children left follow-up before specify exactly the diagnosis, and 109 were studied. In 119 children referred it was found 187 dilated units, since 78 had a prenatal bilateral dilation. Of 109 children studied, 69 were of male sex with 118 dilated kidney units, and 40 were of female sex presenting with dilation in 69 units. We found vesicoureteral reflux in 22 patients (20, 1 percent) and 33 flowed back units, since in 11 children reflux was bilateral. There was a predominance of high degree reflux (IV and V). CONCLUSIONS: Among dilations of urinary tract followed in prenatal period, it is necessary to find a possible vesicoureteral reflux, which is present in 20 percent of cases. Many of these patients may to have congenital renal affection.

Avaliação das doses de radiação em uretrocistografia miccional de crianças / Evaluation of radiation dose in voiding cystourethrography in children

OBJETIVO: Analisar o produto dose-área, a dose de entrada na pele do paciente e as doses relativas à fluoroscopia e às radiografias em exames de cistouretrografia miccional em crianças. MATERIAIS E MÉTODOS: Foram avaliados os procedimentos em 37 pacientes, realizados por quatro médicos do serviço. As medições foram realizadas com um equipamento composto de uma câmara de ionização acoplada diretamente à saída do tubo de raios X e um eletrômetro (Diamentor) ligado diretamente ao computador, para a coleta dos dados. RESULTADOS: Foi observada alguma heterogeneidade na realização do procedimento, que não segue padrão de técnica radiográfica. São realizadas em média 11 radiografias por exame, usando tempo longo de fluoroscopia, com dose média final mais alta que a encontrada em referências da literatura. CONCLUSÃO: A adoção da técnica de alta quilovoltagem nas radiografias e o uso restrito da fluoroscopia podem proporcionar importante redução das doses durante a realização deste procedimento, porque o maior contribuinte para as altas doses verificadas foi a utilização da fluoroscopia.

OBJECTIVE: To evaluate dose-area product, skin entrance dose and doses from fluoroscopy and radiography in voiding cystourethrography studies of pediatric patients. MATERIALS AND METHODS: Procedures performed in 37 patients by four physicians of the institution were evaluated. Measurements were performed with an equipment including an ionization chamber directly coupled to the x-ray tube window and an electrometer (Diamentor) connected to a computer for data collection. RESULTS: Some procedures heterogeneity was observed and guidelines for good radiographic techniques were not followed. On average, 11 radiographies are performed for each study, with extended fluoroscopy time delivering a higher average final dose than those reported in the literature. CONCLUSION: The adoption of radiography with high kilovoltage technique and restricted utilization of fluoroscopy can result in a significant reduction of doses during this procedure, considering that the major contribution to the final dose comes from fluoroscopy.

Correlation between the Severity of Hydronephrosis and the Presence of VUR in Neonate

PURPOSE: The increasing use of ultrasonography has allowed for an increase in the of the detection of congenital hydronephrosis, and the clinical outcomes of congenital hydronephrosis are widely varied. In this study, the necessity of voiding cystourethrography in neonate with hydronephrosis to rule out vesicoureteral reflux (VUR) was evaluated. METHODS: Between January 2004 and December 2007, we reviewed the medical record of 157 childrens with congenital hydronephrosis detected within 1 month of age. The severity of hydronephrosis was graded by SFU (Society of Fetal Urology) system, and anterior posterior pelvic diameter (APPD). We evaluated the relationship between severity of hydronephrosis and incidence of VUR by using SPSS windows version 16.0. A P-value0.05). In addition, there was no statistical significance between APPD, laterality of hydronephrosis and VUR incidence. However, renal units with VUR had lower spontaneous resolution rate (P<0.05), compared to renal units without VUR. CONCLUSION: In this study, there was no statistical significance between the severity of hydronephrosis and presence of VUR. Therefore, voiding cystourethrogram is recommended for all children with hydronephrosis to rule out VUR, regardless of the severity of hydronephrosis.

A Necessity for Lumbar Puncture and VCUG in Febrile UTI Infants less than 3 Months of Age

PURPOSE: Our aim is to reduce the rate of lumbar spinal tapping and voiding cystourethrography (VCUG) in febrile urinary tract infection (UTI) infants less than 3 months of age. METHODS: We reviewed the prevalence of UTI, sepsis, meningitis and UTI with bacterial meningitis in febrile infants less than 3 months of age during the period from Jan. 2001 to Jun. 2008. Renal ultrasonography, Technetium-99m dimercaptosuccinic acid (DMSA) renal scan or VCUG were performed in infants with UTI. Infants with UTI were divided into two groups according to the presence of abnormal findings of ultrasonography and DMSA renal scan : group 1-Infants in whom both ultrasonography and DMSA were normal, group 2-Infants in whom ultrasonography or DMSA were abnormal. Prevalence of VUR was compared between the two groups. We followed up the clinical course of patients who had VUR in group 1. RESULTS: Among 1962 Infants, UTI, sepsis and bacterial meningitis were diagnosed in 620 (31.6%), 63 (3.2%), 8 (0.4%) respectively. Lumbar puncture was performed in 413 (66.6%) infants with UTI and we did not detect a case of bacterial meningitis in association. 348 infants with proven UTI were undergone ultrasonography, DMSA, VCUG. In group 1 with 110 infants (31.6%), the presence of VUR was 4 (3.6%). In group 2 with 238 infants (68.4%), the presence of VUR was 51 (21.4%). Abnormal findings of ultrasonography or DMSA renal scan were closely related with high grade VUR. Most of patients with VUR in group1 had good prognosis. CONCLUSION: Lumbar puncture and VCUG are invasive procedures. Therefore we should decide whether to perform lumbar puncture or VCUG in infants less than 3 months. of age with their first febrile UTI.

Factors Related to the Resolution of Primary Vesicoureteral Reflux

PURPOSE: This study was performed to identify factors related to the resolution of primary vesicoureteral reflux (VUR) in infants. METHODS: We reviewed 183 infants (M : F=149 : 34) diagnosed as urinary tract infection (UTI) between February 2002 and July 2007 at Sanggye Paik Hospital. The diagnosis of UTI was made by culture from a urine specimen obtained by suprapubic puncture (n=97), catheterization (n=83), or collection bag method (n=3, twice positive culture of same organism). All of the infants were performed renal ultrasonography, DMSA scan and voiding cystourethrography (VCUG) study. Follow-up imaging consisted of contrast VCUG or direct isotope VCUG at interval of 1 year. We evaluated the relationship of clinical and laboratory finding, radiologic finding in infants with VUR. RESULTS: Among 51 VUR patients, 18 infants had grade I-II, 12 infants had grade III and the other 21 patients had grade IV-V. Abnormal findings including hydronephrosis on renal ultrasonography were not correlated with severity of VUR. However, the incidence of renal defect in the first DMSA scan showed a tendency of direct correlation with severity of VUR in female patients only (P<0.001). There was significant difference of resolution rate in three VUR groups (grade I-II, III, IV-V) in male patients only (P=0.025). Resolution rate was higher for male patients with unilateral VUR than bilateral (P<0.001). But unilaterality had not any affect on VUR resolution in female VUR patients (P=0.786). Resolution rate was higher for VUR patients without renal scar than VUR patients with renal scar (P<0.001). CONCLUSION: According to our findings, grade of VUR, laterality and renal scar are the factors that contribute to resolution of primary VUR in male and female infants differently.

Vesicoureteral Reflux and Urinary Tract Infection in Children with Congenital Hydronephrosis

PURPOSE: We checked voiding cystourethrography (VCUG) in patients with congenital hydronephrosis (CHN) and followed up the occurrence of urinary tract infection(UTI) in these patients. And we tried to figure out the relationship between CHN and VUR and UTI. METHODS: We performed a retrospective study in 122 CHN patients who received VCUG from 2002 to 2008 at Ajou University Hospital. We executed logistic regression, chi-square test and T-test using version 16.0 SPSS package for the statistical analysis. P<0.05 was regarded as significant. RESULTS: Most patients with CHN were male (73%) and there was a tendency of preferences for unilateral (77%) and left (84%) occurrence of hydronephrosis. The incidence of VUR was 18.9 % among 122 CHN patients and no laterality difference was found to the severity of VUR or hydronephrosis. The incidences of VUR and UTI was higher in group of higher grade (III-IV) CHN patients, when compared to the lower group, respectively. When VUR was present in CHN patients, the incidence of UTI during infancy was also higher. CONCLUSION: The incidence of VUR was higher in patients with higher grades of CHN. The incidence of UTI during infancy was higher when VUR was present in the CHN patients.

Changes of Clinical Findings of Acute Poststreptococcal Glomerulonephritis

PURPOSE: Several studies have reported the recent increase in the incidence of acute poststreptococcal glomerulonephritis(APSGN). The objective of this study is to see changes of clinical findings/manifwstation in children with APSGN. METHODS: Medical records of 63 children who were diagnosed with APSGN in the deparment of Pediatrics, Kyungpook National University Hospital, between January 1992 and December 2006 were reviewed retrospectively. We analyzed various clinical characteristics such as age, sex, degrees of proteinuria, degrees of hematuria, and presence or absence of histories of systemic antibiotic use in children with APSGN, and compared the children with APSGN who were diagnosed between 1992 and 2000 to those who were diagnosed between 2001 and 2006. RESULTS: Age of the patients ranged from 2-14 years(median 7.11 years) at the time of disease onset. Study patients consisted of 41 boys and 22 girls. APSGN followed infection of the throat in 87% of cases. Patient developed an acute nephritic syndrome 12 days after an antecedent streptococcal pharyngitis. Forty patients presented with gross hematuria. Fortyone patients had hypertension at the time of diagnosis. Hypertension disappeared within 7.8+/-8.2 days, gross hematuria within 11.3+/-17.2 days and microscopic hematuria within 3.5+/-3.9 months from the disease onset. Patients in 2001-2006 had significantly higher increase of antistreptolysin O(ASO) titer. However, no significant differences in clinical characteristics were observed. Age, sex, severity of proteinuria, gross or microscopic hematuria, antibiotic therapy did not affect the clinical manifestations of glomerulonephritis. In other words, hypertension, duration of hematuria, recovery of serum C3 level are not different between the two time periods. CONCLUSION: Our data indicates that patients in 2001-2006 had significantly higher level of ASO titer. However, they did not show significant clinical differences. To evaluate the causes of the resurgence of APSGN, a national epidemic is needed.

Should Voiding Cystourethrography be Performed for Infants with Urinary Tract Infection?

PURPOSE: This study was performed to assess necessity of voiding cystourethrography (VCUG) for infants with urinary tract infection(UTI) who had both normal renal sonography and normal DMSA renal scans. METHODS: We reviewed 117 infants hospitalized for UTI between February 2002 and July 2007 at Sanggye Paik Hospital. The diagnosis of UTI was made by culture from a urine specimen obtained by suprapubic puncture(n=57), catheterization(n=58), or collection bag method (n=2, twice positive culture of the same organism). All patients had undergone renal sonography, DMSA renal scan and VCUG. Children with both normal renal sonography and normal DMSA renal scans were evaluated for the presence or severity of vesicoureteral reflux (VUR). RESULTS: Of the 117 patients, 96 were boys and 21 were girls. 28 patients(23.9%) had VUR. 59(50.4%) showed both normal renal sonography and normal DMSA renal scans. Among these 59 patients, 7(11.9%) showed VUR. Three of them had grade I-II reflux, two grade III reflux, and the other two grade IV reflux. One of them showed bilateral VUR, grade IV reflux on the right and grade III on the left. CONCLUSIONS: Although the negative predictive value of both normal renal sonography and normal DMSA renal scan for VUR was 88.1%, 7 patients had VUR and two of them had high grade reflux(grade IV). So, we suggest that VCUG should be performed in infants with UTI despite both normal renal sonography and normal DMSA renal scans.

Predictive Value for Vesicoureteral Reflux in Children with Urinary Tract Infection

PURPOSE: The most concerning issue in children with urinary tract infection(UTI) is the probability of underlying genitourinary anomalies and vesicoureteral reflux(VUR), which is frequently associated with renal scarring and eventually end-stage renal disease. Therefore, voiding cystourethrography(VCUG) is usually recommended at the earliest convenient time for children with UTI. However, VCUG is an invasive procedure that requires catheterization and exposure to X-ray. In this study, we aimed to determine the predictability of clinical, laboratory and imaging parameters for VUR in children with UTI. METHODS: Data of children with bacteriologically proven UTI who underwent VCUG were evaluated retrospectively for clinical(age, gender, fever), laboratory(leukocytosis, ESR, CRP, pyuria, blood urea nitrogen, serum creatinine) and imaging(renal ultrasound and DMSA renal scan) findings. First, children with UTI were divided into two groups according to the presence of VUR as non-VUR group and with VUR group, and clinical, laboratory variables were compared between these groups. Second, patients who had VUR were reclassified as low- grade VUR(grade I-II) group and high-grade(grade III-V) VUR group according to grading of VUR, and clinical, laboratory and imaging variables were compared between these groups. RESULTS: Among 410 children with UTI, 137 had VUR and 78 high-grade VUR. Fever, leukocytosis, ESR, CRP, pyuria were associated with VUR. In addition, abnormal findings of ultrasonography and DMSA renal scan were closely related to VUR. However, these clinical and laboratory variable in patients with high grade VUR were not different significantly, compared to those with low-grade VUR group. CONCLUSIONS: Fever, leukocytosis, ESR, CRP seems to be potentially useful predictors of VUR in pediatric patients with UTI. In addition, renal ultrasonography and DMSA renal scan findings supported the presence of VUR. Further study of these findings could limit unnecessary VCUG in patients with UTI.

Urinary Tract Infection Following Voiding Cystourethrography

PURPOSE: Voiding cystourethrography(VCUG) is required to detect vesicoureteral reflux(VUR), which may manifest as urinary tract infection(UTI) in children. It is well known that VCUG can cause UTI(post-VCUG UTI). In this study, risk factors for post-VCUG UTI and the preventive effect of antibiotics against this complication of VCUG were explored. METHODS: Medical records of 284 patients who underwent VCUG at our hospital in 2007 were reviewed retrospectively. The incidence of post-VCUG UTI and risk factors for post-VCUG UTI, and the impact of antibiotic use on prevention of post-VCUG UTI were evaluated. According to antibiotics usage, we divided the enrolled patients into 4 groups of noantibiotics group, prophylactic antibiotics group(prophylactic antibiotics having been used before), antibiotics-for-VCUG group(antibiotics added for VCUG) and antibiotics-for-treatment group(treatment dose of antibiotics). RESULTS: Seven of 284 children(2.5%) developed UTI after they underwent VCUG. High-grade(grade> or =III) VUR was the only statistically significant risk factor(odds ratio[OR] 6.266, P=0.026) for post-VCUG UTI, while sex, age, and other anomalies of urinary system were not significant. Five post-VCUG UTI cases belonged to prophylactic antibiotics group. Antibiotics use (three groups using antibiotics vs. no-antibiotics group) or addition of antibiotics for VCUG (antibiotics-for-VCUG vs. other groups) did not have any effect on prevention of post-VCUG UTI. CONCLUSION: The risk factor for post-VCUG UTI was high-grade VUR. Antibiotics use did not prevent post-VCUG UTI in this study.

Study of Post Procedural Complications Associated with Voiding Cystourethrography

PURPOSE: Voiding cystourethrography(VCUG) is a commonly performed diagnostic procedure in children with urinary tract infections. Recently, with the widespread use of prenatal ultrasonography, VCUG is performed as part of the postnatal radiological evaluation of asymptomatic infants with prenatally detected hydronephrosis. The procedure is relatively simple but it involves discomfort and some complications. We studied post procedural symptoms and complications in children who underwent VCUG. METHODS: This study reviewed 269 patients who underwent VCUG in our hospital between October 2005 and September 2006. We did a chart review and a telephone interview with the patients' parents about symptoms and complications associated with VCUG. RESULTS: Among 269 children, 217 patients(80.7%) were under 2 years of age and 5 patients (1.9%) were over 8 years of age. Their mean age was 13.1+/-22.9 months. After VCUG, dysuria was found in 49 patients presented with dysuria, and irritability in 36 patients with irritability. Other complications were hematuria, fever, frequency, bladder rupture and urinary tract infection. Mean symptoms duration was 1.4+/-0.7 days. There was no significant relationship between prophylactic antibiotics use and complication rate associated with VCUG. CONCLUSION: Our study demonstrated that 32.7% of patients showed complications including bladder rupture and urinary tract infection after VCUG. We also found that prophylactic antibiotics use did not prevent urinary tract infection nor decrease the rate of complications associated with VCUG. Therefore, we suggest that the procedure must be done carefully and aseptically, and we should closely observe the children who undergo VCUG for development of possible complications.

Voiding cystourethrography in children with an initial episode of febrile urinary tract infection / 소아과

PURPOSE: Because voiding cystourethrography(VCUG) is an invasive method, we studied whether VCUG could be postponed through evaluation of alternative non-invasive tests including renal ultrasonography and (99m)Tc-DMSA renal scan. METHODS: We reviewed the medical records of 175 patients initially diagnosed with febrile urinary tract infection during the one year period of 1999, and compared 3-tests:renal ultrasongraphy, (99m)Tc-DMSA renal scan, and VCUG. RESULTS: Renal ultrasonography didn't contribute to the prognostication of pyelonephritis(photopenic areas) or vesicoureteral reflux(VUR). Presentation of photopenic areas in (99m)Tc-DMSA renal scan was related to VUR. If both findings of renal ultrasonography and (99m)Tc-DMSA renal scans were normal, this condition was closely related to normal results in VCUG. And if both examinations were abnormal, the condition was closely related to VUR. But this state could not always guarantee the normal result from VCUG because of low sensitivity in finding VUR. CONCLUSION: In cases in which acute phyelonephritis is demonstrated by (99m)Tc-DMSA renal scan, VCUG is required. In addition to this, if the conditions of hydronephrosis, vesicoureteral dilatation, increases of renal volume, and changes of echogenesity are shown by renal ultrasonography, VCUG should be performed. If a patient has difficulty undergoing VCUG, temporary postponement of VCUG can be taken into consideration, but only in cases where both examinations of renal ultrasonography and (99m)Tc-DMSA renal scan are normal. Nevertheless, close observation is be advised even in this case.