Abstract
Objective: To prospectively evaluate the diagnostic utility of interlobar renal arterial resistive index values, in predicting the presence of vesicoureteral reflux in children with sonographically normal appearing kidneys. Methods: We investigated 35 children with a history of urinary tract infection with grayscale and color Doppler ultrasound (US) fol-lowed by a standard voiding cystouretherogram to assess the presence of vesicoureteral reflux. All renal units (individ-ual kidneys) were morphologically normal without evidence of hydronephrosis. Resistive index (RI) was measured at the level of the interlobar arteries. Results: Of a total of 67 kidney units, 3 kidney units yielded no diagnostic results due to technical factors (crying, agitation). 46 kidney units (69%) were not associated with any degree of reflux. 17 kidney units (25%) were associated with low-mid grade reflux (grades I - III). 4 kidney units (6%) were associated with high grade reflux (grades IV - V). No statistically significant correlation was found between the interlobar resistive indices of sonographically normal appearing kidneys and the presence, absence, or degree of vesicoureteral reflux. Conclusions: The results of this study suggest that resistive index measurements taken in the interlobar arteries of sonographically normal appearing kidneys cannot be used to predict the presence or absence of vesicoureteral reflux.
Highlights
Urinary tract infections are very common in the pediatric population, especially in girls
We investigated 35 children with a history of urinary tract infection with grayscale and color Doppler ultrasound (US) followed by a standard voiding cystouretherogram to assess the presence of vesicoureteral reflux
The results of this study suggest that resistive index measurements taken in the interlobar arteries of sonographically normal appearing kidneys cannot be used to predict the presence or absence of vesicoureteral reflux
Summary
Urinary tract infections are very common in the pediatric population, especially in girls. Regardless of the new AAP recommendations, it has been shown that a normal renal sonogram does not exclude the presence of vesicoureteral reflux, even in children aged 5 years or older. In that study no significant changes in renal vascular resistance was found between normal kidneys and those in which there was elevated ureteric pressure. Our study was performed in effort to evaluate the following research questions: 1) Is there an alteration of the resistive indices of the interlobar arteries, in children with reflux and sonographically normal appearing kidneys?. Given the known pathophysiology of reflux and renal blood flow in animals with reflux, our hypothesis was that resistive index would not be a positive predictor of reflux in children, and not a useful tool to predict the presence or absence of reflux in normal appearing kidneys on sonography
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