571 ULTRASONOGRAPHY RENAL PARENCHYMAL AREA PREDICTS VESICOURETERAL REFLUX AFTER URINARY TRACT INFECTION

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You have accessJournal of UrologyPediatrics: Imaging/Infections & Vesicoureteral Reflux1 Apr 2011571 ULTRASONOGRAPHY RENAL PARENCHYMAL AREA PREDICTS VESICOURETERAL REFLUX AFTER URINARY TRACT INFECTION Liam MacLeod, Raymond Balise, and Linda Shortliffe Liam MacLeodLiam MacLeod Stanford, CA More articles by this author , Raymond BaliseRaymond Balise Stanford, CA More articles by this author , and Linda ShortliffeLinda Shortliffe Stanford, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1381AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Children who have urinary tract infection (UTI) have risk of vesicoureteral reflux (VUR). There are few factors with which to predict VUR likelihood prior to VCUG and there are no standardized stratification criteria. For this reason clinical effectiveness of performing voiding cystourethrogram (VCUG) in children after UTI is controversial. We have shown that ultrasonography renal parenchymal area (RPA) correlates with vesicoureteral reflux (VUR) in children with UTI. We examined whether RPA can predict VUR in children undergoing VCUG for UTI. METHODS With human subjects approval for database maintenance, we searched radiology requests designating UTI as reason for VCUG from 2000–2008 at Lucile Packard Children's Hospital Stanford. Children from 2–72 months of age with a VCUG and renal and bladder ultrasonogram performed within 6 weeks were analyzed. Children with systemic diseases other than UTI and/or VUR and those with other concomitant genitourinary abnormalities were eliminated from study. Using NIH Scion imaging software, RPA was determined for right and left kidneys. Patient age, left and right RPA, VUR status, and grade were recorded. RPA for right, left, and total (R+L) were analyzed by patient age and VUR status. Patient data were analyzed for statistical differences between groups using SAS software. RESULTS From over 3000 VCUG requisitions, 312 children (624 kidneys) with UTI were evaluated; 187 have no VUR, 66 have bilateral and 59 unilateral VUR ranging from grades 1–5. 37 kidneys demonstrate severe VUR (grades 4–5) and 145 some VUR (grades 1–3). RPA for kidneys without VUR and those with severe VUR show significant differences. RPA for kidneys with VUR (grades 1–3) and VUR (grades 4–5) also differ. Renal size discrepancies with VUR appear to persist with increasing patient age. When L+R data are analyzed in quartiles by age, a model utilizing R+L and age predicts likelihood of severe VUR (grades 4–5) with an ROC curve (for sensitivity versus 1-Specificity) of 0.745. CONCLUSIONS In children having VCUG for UTI, children can be grouped into those who have VUR and those who do not. Children with UTI who have VUR on VCUG have decreased RPA and those who have severe VUR (grades 4–5) can be predicted with high likelihood using this model. RPA may be a useful factor in determining VUR risk in children who have UTI and advising which should undergo VCUG. Further investigation of RPA measurement and prospective testing are required to determine clinical utility of this model. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e230 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Liam MacLeod Stanford, CA More articles by this author Raymond Balise Stanford, CA More articles by this author Linda Shortliffe Stanford, CA More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...