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KMID : 0811820080120020178
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Journal of Korean Society of Pediatric Nephrology
2008 Volume.12 No. 2 p.178 ~ p.185
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Prediction of High Grade Vesicoureteral Reflux in Infants Less than 3 Months with Urinary Tract Infection
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Yi Dae-Yong
Tchah Hann
Shim So-Yeon
Kim Na-Yeon
Son Dong-Woo
Jeon In-Cheol
Cho Hee-Yeon
Kim Ji-Eun
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Abstract
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Purpose : Our aim was to investigate the predictive factors for detecting grade III-V vesicoureteral reflux(VUR) in young infants less than 3 months with urinary tract infections (UTI).
Methods : Data of infants who underwent ultrasonography and VCUG between January 2004 and September 2007 were reviewed. Age, gender, incidence of bacteremia, C-reactive protein(CRP) and imaging studies were compared between group I(grade III-V VUR) and group II (normal or grade I and II VUR) retrospectively. Sensitivity, specificity, positive and negative predictive values, odds ratio, and likelihood ratio of ultrasonography for high grade VUR were evaluated.
Results : Among 54 enrolled infants(41 males, 13 females), 14 infants were group I and 40 infants were group II. In the group I, CRP level was significantly higher(6.115.18 vs. 3.273.45, P=0.025), and there were more ultrasonographic abnormal findings(71.4%, vs. 22.5%, P=0.002) compared with group II. However, ultrasonography was the only significant factor after adjusting with logistic regression(P=0.002). Incidence of bacteremia and abnormal DMSA findings were not significantly different in two groups. Sensitivity, specificity, and odds ratio of ultrasonography was 71.4%, 77.5%, 6.9 respectively. Negative predictive value was 88.6% and negative likelihood ratio was 0.37. Ultrasonography had significant negative likelihood ratio for grade III-V VUR, but missed 4 infants with grade III VUR.
Conclusion : We could not find any alternative predictive factors to reduce VCUG in detecting high grade VUR. Therefore, VCUG must be considered in young infants less than 3 months with UTI.
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KEYWORD
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Urinary tract infection, Vesicoureteral reflux, Ultrasonography
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