Evaluation of the Laboratory and Sonographic Findings of Vesicoureteral Reflux in Children with Acute Febrile Urinary Tract Infection

Abstract

Background: Vesicoureteral reflux (VUR) is one of the most common underlying urologic abnormalities in children with acute febrile urinary tract infection (UTI). Therefore, evaluating VUR in all patients with acute pyelonephritis (APN) is necessary to prevent further complications. Objectives: The purpose of this study was to investigate the value of laboratory and imaging findings in children with acute febrile UTI in determining the need for cystographic examinations for VUR. Methods: A total of 424 children with their first febrile UTI were evaluated in two groups: Those with VUR (n = 204) and those without VUR (n = 220). Patients with secondary VUR were excluded from the study. Variables such as acute phase reactants, serum creatinine (Cr), and urine culture were obtained at the time of admission and before antibiotic treatment. Results: Vesicoureteral reflux was significantly more common in males (P = 0.001), in those with higher serum Cr at admission (P < 0.001), in patients with abnormal renal bladder ultrasound (P < 0.001), and in cases with the growth of non-Escherichia coli organisms compared to those without VUR. Serum Cr and abnormal ultrasound showed a significant correlation with VUR in multivariate analysis. Additionally, serum Cr and abnormal ultrasound were moderately accurate predictors of VUR, with moderate sensitivity and specificity. Conclusions: Investigation of primary VUR among children with acute febrile UTI is recommended for those with increased serum Cr and abnormal renal bladder ultrasonography.