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 journalArticle

29 Citations (Scopus)

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)856-866
Number of pages11
JournalJournal of Pediatric Urology
Volume9
Issue number6 PART A
DOIs
StatePublished - Dec 2013

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Cicatrix
Observational Studies
Succimer
Fever
Cross-Sectional Studies
Kidney
Area Under Curve
Logistic Models

Keywords

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

ASJC Scopus subject areas

  • Urology
  • Pediatrics, Perinatology, and Child Health

Cite this

Prevalence and risk factors for renal scars in children with febrile UTI and/or VUR : A cross-sectional observational study of 565 consecutive patients. / Snodgrass, Warren T.; Shah, Anjana; Yang, Mary; Kwon, Jeannie; Villanueva, Carlos; Traylor, Janelle; Pritzker, Karen; Nakonezny, Paul A.; Haley, Robert W.; Bush, Nicol Corbin.

In: Journal of Pediatric Urology, Vol. 9, No. 6 PART A, 12.2013, p. 856-866.

Research output: Contribution to journalArticle

Snodgrass, Warren T. ; Shah, Anjana ; Yang, Mary ; Kwon, Jeannie ; Villanueva, Carlos ; Traylor, Janelle ; Pritzker, Karen ; Nakonezny, Paul A. ; Haley, Robert W. ; Bush, Nicol Corbin. / Prevalence and risk factors for renal scars in children with febrile UTI and/or VUR : A cross-sectional observational study of 565 consecutive patients. In: Journal of Pediatric Urology. 2013 ; Vol. 9, No. 6 PART A. pp. 856-866.
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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.",
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AU - Yang, Mary

AU - Kwon, Jeannie

AU - Villanueva, Carlos

AU - Traylor, Janelle

AU - Pritzker, Karen

AU - Nakonezny, Paul A.

AU - Haley, Robert W.

AU - Bush, Nicol Corbin

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AB - 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.

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