| The relationships between clinical variables and renal parenchymal disease in pediatric clinically suspected urinary tract infection |
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Jung Lim Byun, Sang Taek Lee, Sochung Chung, Kyo Sun Kim |
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Department of Pediatrics, Konkuk University School of Medicine, Seoul, Korea |
| 소아 요로 감염 및 의심 환아에서 신 실질 병변 및 방광요관 역류와 임상 변수와의 연관성 |
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변정림, 이상택, 정소정, 김교순 |
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건국대학교 의학전문대학원 소아과학교실 |
Correspondence:
Kyo Sun Kim, Tel: +82.2-2030-7557, Fax: +82.2-2030-7749, Email: kimkyo@kuh.ac.kr
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| Abstract |
Purpose
: To evaluate the significance of clinical signs and laboratory findings as predictors of renal parenchymal lesions and vesicoureteral reflux (VUR) in childhood urinary tract infection (UTI).
Methods
: From July 2005 to July 2008, 180 patients admitted with a first febrile UTI at the Pediatric Department of Konkuk University Hospital were included in this study. The following were the clinical variables: leukocytosis, elevated C-reactive protein (CRP), positive urine nitrite, positive urine culture, and fever duration both before and after treatment. We evaluated the relationships between clinical variables and dimercaptosuccinic acid (DMSA) scan and voiding cystourethrography (VCUG) results.
Results
: VCUG was performed in 148 patients; of them, 37 (25.0%) had VUR: 18 (12.2%) had low-grade (I-II) VUR, and 19 (10.5%) had high-grade (III-V) VUR. Of the 95 patients who underwent DMSA scanning, 29 (30.5%) had cortical defects, of which 21 (63.6%) had VUR: 10 (30.3%), low-grade (I-II) VUR; and 11 (33.3%), high-grade VUR. Of the 57 patients who were normal on DMSA scan, 8 (14.0%) had low-grade VUR and 6 (10.5%) had high-grade VUR. The sensitivity, specificity, and positive and negative predictive values of the DMSA scan in predicting high-grade VUR were 64.7%, 69.9%, 33.3%, and 89.5%, respectively. Leukocytosis, elevated CRP, and prolonged fever (≥36 hours) after treatment were significantly correlated with the cortical defects on DMSA scans and high-grade VUR.
Conclusion
: Clinical signs, including prolonged fever after treatment, elevated CRP, and leukocytosis, are positive predictors of acute pyelonephritis and high-grade VUR. |
| Key Words:
Urinary tract infection, Vesicoureteral reflux, Tc-99m Dimercaptosuccinic acid, Child |
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