Delayed diagnosis of primary vesicoureteral reflux in children with recurrent urinary tract infections: Diagnostic approach and renal outcomes

Özet

Objective: In this study, we aimed to assess renal outcomes of delayed diagnosis of dilating primary vesicoureteral reflux (VUR) following recurrent febrile urinary tract infections (fUTIs) and its diagnostic imagingprocedures.Material and methods: The medical records of patients who underwent ultrasonography (US), non- acutedimercaptosuccinic acid (Tc-99mDMSA) scintigraphy and voiding cystourethrography (VCUG), and whowere older than 2 years at the time of VUR diagnosis were retrospectively reviewed.Results: A total of 32 children (female, n=27: 84.4%) with a mean age of 7.67±3.34 years at the time ofdiagnosis of VUR were included in the study. Grade III, IV, V VUR were found in 22%, 69%, and 9%of the patients, respectively. At the time of VUR diagnosis, abnormal US findings were detected in 75%of the cases. Tc-99mDMSA detected abnormalities in 83.9% (7 with a single scar, 7 with multiple lesions,12 with reduced kidney function) of the patients. Estimated glomerular filtration rate of 3 patients withbilateral grade IV VUR was <75 mL/min/1.73 m2. In 5 patients (16%), VUR could not be predicted byUS+DMSA scintigraphy (Grade IV VUR in 3 and Grade III in 2 cases ). The sensitivity in predicting VURwas 75.00% (95% CI: 56.60-88.54) and 83.87% (95% CI: 66.27-94.55), respectively, for US alone and combined US+DMSA.Conclusion: VCUG should be performed routinely in addition to US and non-acute DMSA in all childrenreferred with recurrent fUTIs. Awareness of childhood UTI in public and healthcare personnels should beincreased in order to refer these patients at a early stage to pediatric urology and nephrology units.