PURPOSE: To determine prevalence and risk factors for renal scar in children referred for urologic assessment of febrile UTI and/or VUR.
METHODS: Pre-determined risk factors for renal scar were prospectively recorded in consecutive patients referred for UTI/VUR. Age, gender, VUR grade, and reported number of febrile and non-febrile UTIs were analyzed with logistic regression to determine risk for focal cortical defects on non-acute DMSA.
RESULTS: Of 565 consecutive children, 24 (4%) had congenital renal dysplasia and 84 (15.5%) had focal defect(s). VUR, especially grades IV-V, recurrent febrile UTI, and older age increased risk. For any age child with the same number of UTIs, VUR increased odds of renal defect 5.4-fold (OR = 5.4, 95% CI = 2.7-10.6, AUC = 0.759).
CONCLUSIONS: Focal DMSA defects were present in 15.5% of 565 consecutive children referred for febrile UTI and/or VUR; 4% had presumed congenital reflux nephropathy without cortical defect. All VUR grades increased risk for these defects, as did recurrent febrile UTIs and older age. However, 43% with grades IV-V VUR and 76% with recurrent UTI had normal DMSA.
Snodgrass WT, Shah A, Yang M, Kwon J, Villanueva C, Traylor J, Pritzker K, Nakonezny PA, Haley RW, Bush NC. Are you the author?
Division of Pediatric Urology, Department of Urology, University of Texas Southwestern Medical Center, 2350 Stemmons Frwy, Suite D-4300, MC F4.04, Dallas, TX 75207, USA.
Reference: J Pediatr Urol. 2013 Feb 25. pii: S1477-5131(13)00006-5.