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Vesicoureteral reflux in children with suspected and proven urinary tract infection

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Abstract

The aim of this study was to estimate the prevalence of vesicoureteral reflux (VUR) and clinically significant ultrasonography (US) abnormalities in a large group of children with proven and suspected urinary tract infection (UTI). The medical reports on renal US and voiding cystouretrographies (VCUG) of 2,036 children were reviewed. Renal US was performed on all children and VCUG on 1,185 children (58%). Based on the urine culture data, the UTI diagnoses were classified into five reliability classes (proven, likely, unlikely, false and no microbial data). The UTI diagnose was considered proven in 583/2036 (28.6%) and false in 145 (7.1%) cases. The prevalence of VUR was similar among those with proven and false UTI [37.4 vs. 34.8%; relative risk (RR) 1.08, 95% confidence intervals (95% CI) 0.7–1.7, P = 0.75] and decreased with increasing age (P = 0.001). Clinically significant US abnormalities occurred in 87/583 (14.9%) cases with proven UTI and significantly less often (11/145, 7.6%) in the false UTI class (RR 1.96, 95% CI 1.1–3.6, P = 0.02). Our finding supports the claim that VUR is not significantly associated to UTI and that its occurrence among children even without UTI is significantly higher than traditional estimates. This challenges the recommendations of routine VCUG after UTI.

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Acknowledgements

We thank Marja Perhomaa, MD, of the Department of Radiology, Oulu University Hospital, for her help in identifying the survey population.

This study was supported in part by grants from the Alma and K.A. Snellman Foundation, Oulu, Finland, the Juho Vainio Foundation, Finland, the Foundation for Paediatric Research, Finland, and Oulu University Hospital, Finland.

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Paediatrics, University of Oulu, Oulu, P.O. Box 5000, 90014, Finland

    Annukka Hannula, Mika Venhola, Marjo Renko, Tytti Pokka, Niilo-Pekka Huttunen & Matti Uhari

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  1. Annukka Hannula
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  2. Mika Venhola
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  3. Marjo Renko
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  6. Matti Uhari
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Correspondence to Annukka Hannula.

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Hannula, A., Venhola, M., Renko, M. et al. Vesicoureteral reflux in children with suspected and proven urinary tract infection. Pediatr Nephrol 25, 1463–1469 (2010). https://doi.org/10.1007/s00467-010-1542-x

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  • DOI: https://doi.org/10.1007/s00467-010-1542-x

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