Division of Nephrology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Division of Nephrology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
J Urol. 2016 Nov;196(5):1541-1545. doi: 10.1016/j.juro.2016.05.038. Epub 2016 May 12.
We evaluated risk factors and assessed predicted probabilities for grade III or higher vesicoureteral reflux (dilating reflux) in children with a first simple febrile urinary tract infection and normal renal and bladder ultrasound.
Data for 167 children 2 to 72 months old with a first febrile urinary tract infection and normal ultrasound were compared between those who had dilating vesicoureteral reflux (12 patients, 7.2%) and those who did not. Exclusion criteria consisted of history of prenatal hydronephrosis or familial reflux and complicated urinary tract infection. The logistic regression model was used to identify independent variables associated with dilating reflux. Predicted probabilities for dilating reflux were assessed.
Patient age and prevalence of nonEscherichia coli bacteria were greater in children who had dilating reflux compared to those who did not (p = 0.02 and p = 0.004, respectively). Gender distribution was similar between the 2 groups (p = 0.08). In multivariate analysis older age and nonE. coli bacteria independently predicted dilating reflux, with odds ratios of 1.04 (95% CI 1.01-1.07, p = 0.02) and 3.76 (95% CI 1.05-13.39, p = 0.04), respectively. The impact of nonE. coli bacteria on predicted probabilities of dilating reflux increased with patient age.
We support the concept of selective voiding cystourethrogram in children with a first simple febrile urinary tract infection and normal ultrasound. Voiding cystourethrogram should be considered in children with late onset urinary tract infection due to nonE. coli bacteria since they are at risk for dilating reflux even if the ultrasound is normal.
我们评估了首次单纯性发热性尿路感染且肾脏和膀胱超声正常的儿童中出现 III 级或更高级别（扩张性）膀胱输尿管反流的危险因素，并评估了其预测概率。
将 167 例年龄在 2 至 72 个月、首次发热性尿路感染且超声正常的儿童分为存在扩张性膀胱输尿管反流（12 例，7.2%）和不存在扩张性膀胱输尿管反流（155 例）两组，比较两组间的差异。排除标准包括产前肾积水或家族性反流病史以及复杂性尿路感染。采用逻辑回归模型确定与扩张性反流相关的独立变量。评估扩张性反流的预测概率。
与不存在扩张性反流的患儿相比，存在扩张性反流的患儿年龄更大且更常为非大肠埃希菌感染（p=0.02 和 p=0.004），但两组间的性别分布无差异（p=0.08）。多变量分析显示，年龄较大和非大肠埃希菌感染独立预测扩张性反流，比值比分别为 1.04（95%CI 1.01-1.07，p=0.02）和 3.76（95%CI 1.05-13.39，p=0.04）。非大肠埃希菌感染对扩张性反流预测概率的影响随患儿年龄增加而增大。
我们支持对首次单纯性发热性尿路感染且超声正常的儿童选择性行排尿性膀胱尿道造影的观点。对于由非大肠埃希菌感染引起的迟发性尿路感染患儿，即使超声正常，也应考虑行排尿性膀胱尿道造影，因为其存在扩张性反流风险。
