scholarly journals The role of voiding cystourethrography in the investigation of children with urinary tract infections

2016 ◽  
Vol 10 (5-6) ◽  
pp. 210 ◽  
Author(s):  
Linda C. Lee ◽  
Armando J. Lorenzo ◽  
Martin A. Koyle
Keyword(s):  
Urinary Tract ◽  
Vesicoureteral Reflux ◽  
Urinary Tract Infections ◽  
Renal Scarring ◽  
High Rate ◽  
Voiding Cystourethrography ◽  
Low Grade ◽  
Endoscopic Injection ◽  
Febrile Uti ◽  
Tract Infections

Urinary tract infections (UTIs) represent a common bacterial cause of febrile illness in children. Of children presenting with a febrile UTI, 25‒40% are found to have vesicoureteral reflux (VUR). Historically, the concern regarding VUR was that it could lead to recurrent pyelonephritis, renal scarring, hypertension, and chronic kidney disease. As a result, many children underwent invasive surgical procedures to correct VUR. We now know that many cases of VUR are low-grade and have a high rate of spontaneous resolution. The roles of surveillance, antibiotic prophylaxis, endoscopic injection, and ureteral reimplantation surgery also continue to evolve. In turn, these factors have influenced the investigation of febrile UTIs.Voiding cystourethrography (VCUG) is the radiographic test of choice to diagnose VUR. Due to its invasive nature and questionable benefit in many cases, the American Academy of Pediatrics (AAP) no longer recommends VCUG routinely after an initial febrile UTI. Nevertheless, these guidelines pre-date the landmark Randomized Intervention of Children with Vesicoureteral Reflux (RIVUR) trial and there continues to be controversy regarding the diagnosis and management of VUR. This paper discusses the current literature regarding radiographic testing in children with febrile UTIs and presents a practical risk-based approach for deciding when to obtain a VCUG.

scholarly journals Posttransplantation Vesicoureteral Reflux in Renal Grafts and Their Outcomes in Pediatric Transplantation: Should We Be Afraid ?

2021 ◽  
Author(s):  
Demet Alaygut ◽  
Eren Soyaltın ◽  
Elif Perihan Öncel ◽  
İsmail Sert ◽  
Cem Tuğmen ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Vesicoureteral Reflux ◽  
Urinary Tract Infections ◽  
Bladder Capacity ◽  
Voiding Cystourethrography ◽  
Post Transplantation ◽  
Renal Graft ◽  
Recurrent Urinary Tract Infections ◽  
Tract Infections ◽  
Special Assessment

Objective: Demographical, pre-transplantation and post-transplantation features and post-treatment results of four pediatric cases, who had vesicoureteral reflux (VUR) in the graft kidney, were discussed. Methods: Transplantation age, primary diagnosis, VUR to pretransplantation in native kidneys, history of bladder dysfunction, bladder capacity, results of urodynamic studies, donor and its features, induction treatments and ongoing immunosuppressive treatments, acute rejection episodes, CMV and BK infections, VUR grade in the renal graft, DMSA results, treatment type and its outcomes, and the renal graft functions of four patients who underwent kidney transplantation at Tepecik Training and Research Hospital between 2008 and 2016 and for whom VUR was determined via voiding cystourethrography (VCUG) due to recurrent urinary tract infections, were evaluated. Results: All of four cases were female. Their mean transplantation age was 8.7 years (5-16). High grade (Grade 4) VUR was determined in the graft kidney in all but one. DMSA included multiple scar foci apart from one case having low grade VUR. Cases were primarily treated endoscopically and then by open surgery. Spontaneous recovery occurred in one case. Graft dysfunction was not observed in any of the cases. Conclusion: VUR is an important risk factor in recurrent urinary tract infections after post-transplantation. A special assessment should be done for the patient in the presence of VUR and conservative and surgical treatments should be executed together. It should be remembered that VUR can be spontaneously regressed by the bladder capacity increasing treatments and prophylaxis.

scholarly journals The Diagnosis and Treatment of Vesicoureteral Reflux: An Update

2015 ◽  
Vol 8 (1) ◽  
pp. 96-103 ◽  
Author(s):  
Adam Rensing ◽  
Paul Austin
Keyword(s):  
Urinary Tract ◽  
Vesicoureteral Reflux ◽  
Renal Scarring ◽  
Reflux Nephropathy ◽  
Bowel Dysfunction ◽  
Alternative Approach ◽  
Febrile Uti ◽  
Febrile Urinary Tract Infections ◽  
Tract Infections ◽  
Pediatric Providers

Vesicoureteral reflux [VUR] remains a common problem seen by pediatric providers. Despite a great deal of research, the debate regarding how to screen and treat patients reremains tense and controversial. This review seeks to summarize the management of VUR with emphasis on recent published findings in the literature and how they contribute to this debate. The goals of managing VUR include preventing future febrile urinary tract infections [FUTI], renal scarring, reflux nephropathy and hypertension. The topdown approach with upper tract imaging and selective vesicocystourethrogram [VCUG] is an emerging alternative approach in the evaluation of children after their first FUTI. The elimination of bladder and bowel dysfunction [BBD] is an important management strategy to prevent further FUTIs, regardless of treatment choice. Antibiotic prophylaxis is a safe and effective modality to sterilize the urinary tract. Endoscopic treatment of VUR is an attractive modality in select patients, although some concerns remain regarding its effectiveness and durability as compared to to the gold standard of open or laparoscopic ureteroneocystostomy. Lastly, further research is required to determine the most effective algorithm to evaluate the pediatric patient after the first febrile UTI.

scholarly journals Characterizing Patients with Recurrent Urinary Tract Infections in Vesicoureteral Reflux: A Pilot Study of the Urinary Proteome

2020 ◽  
Vol 19 (3) ◽  
pp. 456-466 ◽  
Author(s):  
Dijana Vitko ◽  
Patricia S. Cho ◽  
Stephen A. Kostel ◽  
Shannon E. DiMartino ◽  
Lily D. Cabour ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Vesicoureteral Reflux ◽  
Urinary Tract Infections ◽  
Study Cohort ◽  
Low Grade ◽  
Urinary Proteins ◽  
Recurrent Utis ◽  
Urinary Proteome ◽  
Recurrent Urinary Tract Infections ◽  
Tract Infections

Recurrent urinary tract infections (UTIs) pose a significant burden on the health care system. Underlying mechanisms predisposing children to UTIs and associated changes in the urinary proteome are not well understood. We aimed to investigate the urinary proteome of a subset of children who have vesicoureteral reflux (VUR) and recurrent UTIs because of their risk of developing infection-related renal damage. Improving diagnostic modalities to identify UTI risk factors would significantly alter the clinical management of children with VUR. We profiled the urinary proteomes of 22 VUR patients with low grade VUR (1–3 out of 5), a history of recurrent UTIs, and renal scarring, comparing them to those obtained from 22 age-matched controls. Urinary proteins were analyzed by mass spectrometry followed by protein quantitation based on spectral counting. Of the 2,551 proteins identified across both cohorts, 964 were robustly quantified, as defined by meeting criteria with spectral count (SC) ≥2 in at least 7 patients in either VUR or control cohort. Eighty proteins had differential expression between the two cohorts, with 44 proteins significantly up-regulated and 36 downregulated (q <0.075, FC ≥1.2). Urinary proteins involved in inflammation, acute phase response (APR), modulation of extracellular matrix (ECM), and carbohydrate metabolism were altered among the study cohort.

scholarly journals Frequency of Vesicoureteral Reflux in Children having Recurrent Urinary Tract Infections

Esculapio ◽  
2021 ◽  
Vol 16 (4 (oct 2020 - dec 2020)) ◽  
Author(s):  
Irum Aslam ◽  
Muhammad Asif Siddiqui ◽  
Fatima Zia ◽  
Hafsa Qamar
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Vesicoureteral Reflux ◽  
Urinary Tract Infections ◽  
Renal Scarring ◽  
P Value ◽  
Recurrent Urinary Tract Infections ◽  
The Mean ◽  
Tract Infections

Objective: Repeated urinary tract infections are significantly related to anatomical abnormalities of urinary tract. Vesicoureteral reflux is quite common, under diagnosed anatomical abnormality, leads to renal scarring and chronic kidney disease. The objective of the study was to determine the frequency of vesicoureteral reflux in children having repeated urinary tract infections. Methods: It is cross sectional survey conducted in department of Pediatric Medicine, The Children's Hospital & Institute of Child Health, Lahore, spanning from 20-5-2014 to 19-11-2014, using non-probability purposive sampling, a total of 140 patients included. Each child was screened and followed with repeated urinary tract infections for frequency of vesicoureteral reflux by detailed clinical examination and relevant investigation as defined in operational definition. To avoid any controversy, all the findings of UTI & vesicoureteral reflux was assessed by a single consultant. Data was managed using SPSS version 20. Results: In this study the mean age of all patients was 5.64±2.35 years. There were 42 (30%) males and 98(70%) females in this study with male to female ration 1:233. The mean number of episodes of urinary tract infections was 5.82±1.95 per years. Frequency of vesicoureteral reflux in these patients was seen in 35(25%) of the patients. When we stratified the data over age, gender and number of episodes of urinary tract infection we found significant association of vesicoureteral reflux with age groups only (p-value < 0.05) while no association between vesicoureteral reflux versus gender and number of episodes of urinary tract infection (p- value > 0.05). Conclusion: We found significant correlation between vesicoureteral reflux and repeated urinary tract infections. Cases with repeated urinary tract infections should be investigated thoroughly to address underlying cause, in order to prevent renal damage and long-term complications. Key Words: Paediatric, Urinary tract infections, hydronephrosis, Vesicoureteral reflux How to Cite: Aslam I, Siddiqui MA, Zia F, Qamar H. Frequency of vesicoureteral reflux in children having recurrent urinary tract infections. Esculapio.2020;16(04):18-20.

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