Prevalence and risk factors for renal scars in children with febrile UTI and/or VUR: A cross-sectional observational study of 565 consecutive patients

Warren T. Snodgrass, Anjana Shah, Mary Yang, Jeannie Kwon, Carlos Villanueva, Janelle Traylor, Karen Pritzker, Paul A. Nakonezny, Robert W. Haley, Nicol Corbin Bush

Research output: Contribution to journalArticlepeer-review

32 Scopus citations

Abstract

Purpose: To determine prevalence and risk factors for renal scar in children referred for urologic assessment of febrile UTI and/or VUR. Methods: Pre-determined risk factors for renal scar were prospectively recorded in consecutive patients referred for UTI/VUR. Age, gender, VUR grade, and reported number of febrile and non-febrile UTIs were analyzed with logistic regression to determine risk for focal cortical defects on non-acute DMSA. Results: Of 565 consecutive children, 24 (4%) had congenital renal dysplasia and 84 (15.5%) had focal defect(s). VUR, especially grades IV-V, recurrent febrile UTI, and older age increased risk. For any age child with the same number of UTIs, VUR increased odds of renal defect 5.4-fold (OR = 5.4, 95% CI = 2.7-10.6, AUC = 0.759). Conclusions: Focal DMSA defects were present in 15.5% of 565 consecutive children referred for febrile UTI and/or VUR; 4% had presumed congenital reflux nephropathy without cortical defect. All VUR grades increased risk for these defects, as did recurrent febrile UTIs and older age. However, 43% with grades IV-V VUR and 76% with recurrent UTI had normal DMSA.

Original languageEnglish (US)
Pages (from-to)856-863
Number of pages8
JournalJournal of Pediatric Urology
Volume9
Issue number6 PART A
DOIs
StatePublished - Dec 2013

Keywords

  • DMSA
  • Focal renal cortical defect
  • Renal scar
  • Technetium-99m dimercaptosuccinic acid renography
  • Urinary tract infection
  • Vesicoureteral reflux

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Urology

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