Hellström M, Jacobsson B, Mårild S, Jodal U
Department of Radiology, Sahlgren's Hospital, Gothenburg, Sweden.
AJR Am J Roentgenol. 1989 Apr;152(4):801-4. doi: 10.2214/ajr.152.4.801.
Most children who develop renal damage (scarring) after urinary-tract infection have vesicoureteral reflux. Voiding cystourethrography is therefore usually recommended as the initial radiologic study in children with urinary-tract infection. However, renal damage may occur also in the absence of reflux. The aim of this investigation was to determine the sensitivity and predictive value of reflux during voiding cystourethrography in identifying children at risk for renal damage. Eighty-four consecutive children, 2 months to 6 years old, with nonobstructive, first-known, febrile urinary-tract infection underwent voiding cystourethrography and urography. Twenty-seven (32%) had reflux and 10 (12%) had or developed renal damage. Two of the children and four of the kidneys with renal damage had no reflux at initial examination. The sensitivity of reflux as a marker for renal damage was 80%, specificity was 74%, positive predictive value was 30%, and negative predictive value was 96%. Thus, most children who develop renal damage after urinary-tract infection have reflux during voiding cystourethrography. However, there is a risk, albeit small, for renal damage to occur in the absence of reflux.
大多数在尿路感染后出现肾损伤（瘢痕形成）的儿童存在膀胱输尿管反流。因此，排尿性膀胱尿道造影通常被推荐作为尿路感染患儿的初始影像学检查。然而，在没有反流的情况下也可能发生肾损伤。本研究的目的是确定排尿性膀胱尿道造影时反流在识别有肾损伤风险儿童中的敏感性和预测价值。84名年龄在2个月至6岁之间、患有非梗阻性、首次已知的发热性尿路感染的儿童接受了排尿性膀胱尿道造影和尿路造影。27名（32%）有反流，10名（12%）有或发生了肾损伤。两名儿童以及4个有肾损伤的肾脏在初次检查时没有反流。反流作为肾损伤标志物的敏感性为80%，特异性为74%，阳性预测值为30%，阴性预测值为96%。因此，大多数在尿路感染后出现肾损伤的儿童在排尿性膀胱尿道造影时有反流。然而，在没有反流的情况下仍有发生肾损伤的风险，尽管风险很小。
