VESICOURETERAL REFLUX - AN ACCURATE PREDICTOR OF ACUTE PYELONEPHRITISIN CHILDHOOD URINARY-TRACT INFECTION

PURPOSE: To determine the association between vesicoureteral reflux (V UR) and the presence of acute pyelonephritis in children with urinary tract infections. MATERIALS AND METHODS: The authors studied 150 conse cutive patients less than 5 years of age with their first proved urina ry tract infection. All patients underwent renal cortical scintigraphy (with technetium-99m dimercaptosuccinic acid or Tc-99m gluconate) and voiding cystourethrography (VCUG) to identify the presence of cortica l defects and VUR, respectively. RESULTS: Of 300 kidneys, 88 (29.3%) h ad a cortical defect at scintigraphy. Fifty-four of the 88 patients (6 1%) did not have VUR demonstrated at VCUG. Conversely, 72 of the 300 k idneys (24%) had VUR; of these, 38 (53%) had no cortical defect. The s ensitivity of VCUG in helping predict a defect was 38.6%, and the spec ificity was 82.1%. CONCLUSION VUR (as shown by VCUG) and renal cortica l scintigraphic defects frequently occur independently of each other. Renal cortical scintigraphy may be a more accurate predictor of patien ts at risk for scarring.