Hilla Bahat1,2, Mai Ben-Ari3, Tomer Ziv-Baran4,5, Amos Neheman4,6, Ilan Youngster3,4, Michael Goldman3,4. 1. Department of Pediatrics, Assaf Harofeh Medical Center, 70300, Zerifin, Israel. hilla.bahat@gmail.com. 2. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. hilla.bahat@gmail.com. 3. Department of Pediatrics, Assaf Harofeh Medical Center, 70300, Zerifin, Israel. 4. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. 5. Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 6. Department of Urology, Assaf Harofeh Medical Center, Zerifin, Israel.
Abstract
BACKGROUND: This study aimed to assess predictors for grade 3-5 vesicoureteral reflux (VUR) in infants ≤ 2 months of age admitted for first urinary tract infection (UTI). METHODS: Retrospective cohort study of 195 infants ≤ 2 months admitted to a pediatric ward for first UTI between 2006 and 2017. Clinical, laboratory, and imaging data were collected from electronic medical charts. We examined associations between grade 3-5 VUR and different patient characteristics. RESULTS: Twenty infants (10%) were diagnosed with grade 3-5 VUR; all had fever. Infants with grade 3-5 VUR had higher blood neutrophil percentage (BNP) (65% vs. 46%, P < 0.001), higher neutrophil-to-lymphocyte ratio (NLR) (2.6 vs. 1.3, P < 0.001), more renal ultrasound abnormalities (prenatal 26% vs. 5%, P = 0.007; postnatal 84% vs. 55%, P = 0.015), and Pseudomonas UTI (15% vs. 1%, respectively, P < 0.001). NLR > 1.65 showed sensitivity 100% and specificity 61% for detecting grade 3-5 VUR. BNP > 53% showed sensitivity 100% and specificity 60% for detecting grade 3-5 VUR. BNP was the best single marker for grade 3-5 VUR with area under the curve (AUC) of 0.82 (95% CI 0.75-0.89). In a multivariate model, AUC for combination of BNP and hydronephrosis was 0.86 (95% CI 0.79-0.93, P = 0.007). CONCLUSIONS: Infants ≤ 2 months of age admitted for a first UTI are at risk for grade 3-5 VUR and thus should undergo a voiding cystourethrography (VCUG) if their renal ultrasound is abnormal or if they have Pseudomonas UTI. Avoiding VCUG can be considered in afebrile infants and in infants with BNP < 53% or NLR < 1.65.
BACKGROUND: This study aimed to assess predictors for grade 3-5 vesicoureteral reflux (VUR) in infants ≤ 2 months of age admitted for first urinary tract infection (UTI). METHODS: Retrospective cohort study of 195 infants ≤ 2 months admitted to a pediatric ward for first UTI between 2006 and 2017. Clinical, laboratory, and imaging data were collected from electronic medical charts. We examined associations between grade 3-5 VUR and different patient characteristics. RESULTS: Twenty infants (10%) were diagnosed with grade 3-5 VUR; all had fever. Infants with grade 3-5 VUR had higher blood neutrophil percentage (BNP) (65% vs. 46%, P < 0.001), higher neutrophil-to-lymphocyte ratio (NLR) (2.6 vs. 1.3, P < 0.001), more renal ultrasound abnormalities (prenatal 26% vs. 5%, P = 0.007; postnatal 84% vs. 55%, P = 0.015), and Pseudomonas UTI (15% vs. 1%, respectively, P < 0.001). NLR > 1.65 showed sensitivity 100% and specificity 61% for detecting grade 3-5 VUR. BNP > 53% showed sensitivity 100% and specificity 60% for detecting grade 3-5 VUR. BNP was the best single marker for grade 3-5 VUR with area under the curve (AUC) of 0.82 (95% CI 0.75-0.89). In a multivariate model, AUC for combination of BNP and hydronephrosis was 0.86 (95% CI 0.79-0.93, P = 0.007). CONCLUSIONS:Infants ≤ 2 months of age admitted for a first UTI are at risk for grade 3-5 VUR and thus should undergo a voiding cystourethrography (VCUG) if their renal ultrasound is abnormal or if they have Pseudomonas UTI. Avoiding VCUG can be considered in afebrile infants and in infants with BNP < 53% or NLR < 1.65.
Entities:
Keywords:
Urinary tract infection; Vesicoureteral reflux; Voiding cystourethrography; Young infants
Authors: Sowdhamini S Wallace; Wei Zhang; Nadia F Mahmood; Jennifer L Williams; Andrea T Cruz; Charles G Macias; Ricardo A Quinonez; Robert C Orth Journal: AJR Am J Roentgenol Date: 2015-10 Impact factor: 3.959
Authors: Alejandro Hoberman; Saul P Greenfield; Tej K Mattoo; Ron Keren; Ranjiv Mathews; Hans G Pohl; Bradley P Kropp; Steven J Skoog; Caleb P Nelson; Marva Moxey-Mims; Russell W Chesney; Myra A Carpenter Journal: N Engl J Med Date: 2014-05-04 Impact factor: 91.245
Authors: Fernanda P Costa; Ana C Simões E Silva; Robert H Mak; Joachim H Ix; Mariana A Vasconcelos; Cristiane S Dias; Carolina C Fonseca; Maria Christina L Oliveira; Eduardo A Oliveira Journal: Clin Kidney J Date: 2019-08-19