ISSN 2149-3235 | E-ISSN 2149-3057
Original Article
Delayed diagnosis of primary vesicoureteral reflux in children with recurrent urinary tract infections: Diagnostic approach and renal outcomes
1 Department of Pediatrics, Division of Pediatric Nephrology, Antalya Training and Research Hospital, Antalya, Turkey  
2 Department of Radiology, Antalya Training and Research Hospital, Antalya, Turkey  
3 Department of Urology, Antalya Training and Research Hospital, Antalya, Turkey  
4 Department of Pediatrics, Division of Pediatric Nephrology, Akdeniz University School of Medicine, Antalya, Turkey  
Turk J Urol 2018; 44: 498-502
DOI: 10.5152/tud.2018.98372
Key Words: Child; primary vesicoureteral reflux; recurrent urinary tract infections; reflux nephropathy
Abstract

Objective: In this study, we aimed to assess renal outcomes of delayed diagnosis of dilating primary vesicoureteral reflux (VUR) following recurrent febrile urinary tract infections (fUTIs) and its diagnostic imaging procedures.


Material and methods
: The medical records of patients who underwent ultrasonography (US), non- acute dimercaptosuccinic acid (Tc-99mDMSA) scintigraphy and voiding cystourethrography (VCUG), and who were older than 2 years at the time of VUR diagnosis were retrospectively reviewed.


Results
: A total of 32 children (female, n=27: 84.4%)  with a mean age of 7.67±3.34 years at the time of  diagnosis of VUR  were included in the study. Grade III, IV, V  VUR were found in 22%, 69%, and 9% of the patients,  respectively. At the time of VUR diagnosis, abnormal US findings were detected in 75% of the cases. Tc-99mDMSA detected abnormalities in 83.9% (7 with a single scar, 7 with multiple lesions, 12 with reduced kidney function) of the patients. Estimated glomerular filtration rate of 3 patients with bilateral grade IV VUR was <75 mL/min/1.73 m2. In 5 patients (16%), VUR could not be predicted by US+DMSA scintigraphy (Grade IV VUR in 3 and Grade III in 2 cases ). The sensitivity in predicting VUR was 75.00% (95% CI: 56.60-88.54) and 83.87% (95% CI: 66.27-94.55), respectively, for US alone and combined US+DMSA.


Conclusion
: VCUG should be performed routinely in addition to US and non-acute DMSA in all children referred with recurrent fUTIs. Awareness of childhood UTI in public and healthcare personnels should be increased in order to refer  these patients at a early stage  to pediatric urology and nephrology units.


Cite this article as
: Doğan ÇS, Semerci Koyun N, Kaya Aksoy G, Çekiç B, Savaş M, Çomak E. Delayed diagnosis of primary vesicoureteral reflux in children with recurrent urinary tract infections: diagnostic approach and renal outcomes. Turk J Urol 2018; 44(6): 498-502.

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