Another indication for voiding cystourography?

Abstract

Voiding cystourethrograms (VCUG) are often considered in the evaluation of infants with febrile urinary tract infection (UTI), but there are few additional clear indications for performing them outside of recurrent febrile UTI itself. Hydronephrosis and scarring on kidney ultrasound (US) are included in several guidelines from consensus organizations, including those from the American Academy of Pediatrics (AAP), National Institute for Clinical Excellence (NICE) and the Italian Societies of Pediatric Nephrology and Pediatric Infectivology. The Italian guideline goes further to include other kidney/bladder anomalies and increased kidney echogenicity on US as additional rationale for obtaining a VCUG. In this volume of The Journal, Mohammad et al present retrospective data from their center that would seem to lend additional support to abnormal echogenicity on US as an indication to obtain a VCUG. The presence of increased echogenicity on US in their hands had a low sensitivity for detection of any vesicoureteral reflux (VUR) but was highly specific. Performance of increased echogenicity as a screening test for VUR improved if the analysis was limited to patients with high-grade VUR only (grades 3-5). Similarly, the overall positive predictive value of increased echogenicity for VUR was low (24-44%), but the negative predictive value was good. (77-80%). Although these data ideally require confirmation in a prospective, multicenter study, they do appear to support more detailed analysis of US findings when considering which infant with a febrile UTI requires a voiding cystourethrogram. Article page 201 ▸ Kidney Echogenicity and Vesicoureteral Reflux in Children with Febrile Urinary Tract InfectionThe Journal of PediatricsVol. 242PreviewTo evaluate increased kidney echogenicity as a predictor of vesicoureteral reflux (VUR) in young children with first febrile urinary tract infection (UTI). Full-Text PDF