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The Relationship between Urinary Tract Infection and Vesicourethral Reflux in Children from Eastern Galilee Region-Israel

Haia Nasser, Abo Zaid Said, Shabati Bril, Vigder Fina, Marwan Armaly, Wael Nasser

Background: The incidence of vesicoureteral (VUR) in the general population is less than 1%. Reflux carries an increased risk of pyelonephritis and renal failure. The purpose of the current study was to check whether the voiding cystourethrography (VCUG) test is necessary in most cases of upper urinary tract infection (UTI) in children, and to investigate if there is a correlation between the presence of VUR and urinary tract infection, or the reflux is a random finding that does not require monitoring. In the same time we studied the correlation with various markers of inflammation, renal ultrasound findings (US), 99m technetium (Tc)-dimercapto-succinic acid (DMSA) nuclear renal scans findings, and the clinical presentation.

Methods: The current study is retrospective, based on tests taken at the Poriya medical center in Tiberius (Eastern Galilee population), between 2009-2013. The study includes 88 children up to 2 years that were asked for VCUG. All the children had symptoms of UTI. Prior to performing the imaging tests, the children had laboratory tests (blood, urine, culture), then renal US. VCU was performed within two weeks to one month from the beginning of the complaints, for children up to six month old. Older children did the voiding test after doing DMSA. DMSA was done 3-5 months after the acute UTI.

Results: Approximately 40% (37.5%) of patients suffered from reflux: 66.7% with incorrect DMSA (filling defect/scar) had reflux. Only 18.2% of children with normal DMSA results had reflux. Renal US test was not correlated with VCU results. High inflammation factors levels (CRP, ESR) were found in all subjects with reflux, and only 52.6% of cases with positive reflux had low lymphocytes levels compared with only 14.3% in patients without reflux.

Conclusions: VCUG is not required in most cases of upper UTI. Suitable replacement test can be done by renal DMSA,which has also an added value of detecting a potential renal damage (scars). High levels of inflammation factors, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) strongly suggest a possible existence of reflux. In contrast, lower levels deny the existence of reflux in children with upper UTI.