Prevalence of vesicoureteric reflux

Bibliographic InformationStudy Type & Evidence LevelStudy AimsNumber of patientsPatient CharacteristicsIntervention and comparisonFollow-up & Outcome MeasuresEffect sizeReviewer Comments
Tsai Y;Hsu C;Lin G;Wang C;Cheng C;Huang Y;Yen M;Hsia S;Yan D; 2004 64Study Type: Cohort
Evidence level: 2+
To determine whether renal pelvis dilation on ultrasound was reliable in predicting VUR and to assess the relationship of other clinical information of VUR in children with UTI114 children (228 kidneys)
79 male
35 female
114 children aged 1–60 months admitted with first episode UTI.
Clinical data, renal echo and voiding cystourethrogram results were reported.
Intervention: VCUG
Ultrasound
Follow-up period: n/a
Outcome Measures: Grade of VUR
Renal pelvis size
VUR occurred in 28.9% (33/114) of patients in 20.6% (47/228) kidneys. Severe VUR was observed in 12.3% (14/114) of the patients in 7.9% (18/228) of the kidneys.
Unilateral pelvis size greater than 8mm had 2.4 (p=0.049, 95%CI 1.0, 5.9) times greater risk for VUR and 3.7 (p=0.025, 95%CI 1.2, 11.3) times greater risk for severe reflux. The sensitivity in detecting severe reflux was 27.8% and the specificity was 90.5%. The positive and negative predictive values in suggesting severe VUR were 20.0% and 93.6% respectively. The sum of bilateral pelvis sizes greater than 16mm had a greater risk for VUR and severe reflux (4.1 and 4.6 times) and similar specificity a negative predictive value for severe reflux. Age, gender c-reactive proteins, leukocytosis, pyuria and acute pyelonephritis did not show significant relationships to the reflux.
Chand DH;Rhoades T;Poe SA;Kraus S;Strife CF; 2003 Oct 76Study Type: OtherCase-series
Evidence Level: 3
To determine whether the incidence of VUR differs in children based on age, race and gender and if the incidence and severity of VUR are related to race in girls younger than 7 years presenting for evaluation after UTI.15,504 patients were included.Patients 21 years old or younger who had a VCUG or radionuclide cystogram performed between Jan 1993 and Dec 2001 at a single hospital.Intervention: VCUG or RNCAge, gender
Number with UTI
Number with reflux
Of the children referred for a VCUG or RNC 9912/15504 (64%) were diagnosed with a UTI. Of these 2927/9912 (29.5%) had reflux.
Of the 9912 children who had a VCUG or a nuclide cystogram because of a previous UTI, reflux was significantly less common in black patients, with the odds of a white patient having reflux about three times greater (p<0.001). The incidence of VUR was significantly more common in females and in the youngest age group (>2 years).
2733/8794 (31.1%) white patients with VUR + history of UTI
104/768 (9.6%) black patients with VUR + history of UTI
OR 0.34 (p<0.0001)
2724/8776 (31.0%) females with VUR + history of UTI
203/1136 (17.9%) males with VUR + history of UTI
OR 0.53 (p<0.0001)
1582/4101 (38.6%) <2 years with VUR + history of UTI
1001/3767 (26.6%) 2–6 years with VUR + history of UTI
307/1558 (19.7%) 7–11 years with VUR + history of UTI
37/486 (7.6%) 12–21 years with VUR + history of UTI
Of the children who had a VCUG or a nuclide cystogram because of a previous UTI, 38% were younger than 7 years.
Girls younger than 7 years were further divided into those younger than 2 years and 2–6 years. VUR incidence was consistently higher and were significantly more likely to have high grade reflux than black girls in white girls.
Results for children aged 0 to 11 years reported. Children aged 12–21 were analysed together and 12–16 year old data could not be extracted separately.
Upadhyay J;Bolduc S;Bagli DJ;McLorie GA;Khoury AE;Farhat W; 2003 May 237Study Type: Case-series
Evidence Level: 3
To evaluate the association of dysfunctional voiding with VUR among girls with UTI114 patients with voiding dysfunction.
58 patients presented with a concomitant UTI
Girls evaluated for symptoms of dysfunctional voiding for at least 6 months.Intervention: VCUGNumber with VURIn the 114 patients with dysfunctional voiding symptoms the incidence of concomitant UTI at presentation was 58/114 (51%).
Of these 19 (33%) had VUR which was primary in 16 (84%) and secondary with complete ureteral duplication in 3 (16%). All patients were female and VUR was bilateral in 5.
58/114 (50.8%) had a UTI - only analyses on these children were presented.
Zaki M;Mutari GA;Badawi M;Ramadan D;Al deen HE; 2003 Sep 238Study Type: Case-series
Evidence Level: 3
To determine the frequency of VUR and associated kidney involvement among children with first documented febrile UTI174 children (38 boys and 136 girls)All consecutive children aged under 12 admitted to two regional hospitals in Kuwait with the diagnosis of first febrile UTI over a 6 year period (June 1995 to June 2001) who had undergone MCUG and DMSA.

Positive urine culture defined as 3 urine cultures positive for the same bacterial pathogens by urine collected via catheter, clean-catch or mid-urine stream.
All children had:
Temperatures of >38.5 ºC
Raised ESR (>40mm/h)
CRP (>40 mg/l
Additionally, all males were circumcised.
Exclusions: Children whose parents refused consent for DMSA, neurogenic bladder, and 19 children who were non-Kuaiti Arabs and non-Arab children in order to have a homogeneous racial population.
Intervention: DMSA within the first week of initiating treatment
MCUG at least one month after diagnosis
Comparison: n/a
Prevalence of VUR in children with UTI
DMSA scan results
Microorganism isolated
VUD 39 (22%) 2/3 of which had grade 1 or 2. there was a higher incidence of VUR in girls than boys (girls: 32/136 (24%) vs boys: 7/38 (18%))
Abnormal DMSA scan results in 59/156 (43%) girls and 4/38 (11%) boys.
1< year (72 children)
34 boys and 38 girls
VUD 18/72 (25%)
Abnormal DMSA scan results 13/72 (18%)
Organisms most frequently isolated
E.Coli (55 children) followed
Klebsiella spp.(14 children),
Proteus spp. (2 children) and Enterococci (1 child)
1–5 years (66 patients)
3 boys and 63 girls
VUD 12/66 (18%)
Abnormal DMSA scan results 35/66 (53%)
Organisms most frequently isolated E. coli (62 children) followed by Klebsiella spp. (2 children) and Proteus spp. (2 children)
5 < 12 years (36 patients)
1 boy and 35 girls
VUD 9/36 (25%)
Abnormal DMSA scan results 15/36 (41%)
Organisms most frequently isolated E. coli (34 children) followed by Klebsiella spp. (1 children) and Proteus spp. (1 children)
Howard RG;Roebuck DJ;Yeung PA;Chan KW;Metreweli C; 2001 Apr 239Study Type: Case-series
Evidence Level: 3
To report the prevalence of VUR and scarring in Chinese children.93 children identified
65 male
28 female
All children aged under 5 years who presented with a documented UTI between 1994 and 1999 and who underwent a MCUG and DMSA.
Scarring defined as:
0 = normal
1 = focal scarring in one region
2 = scarring involving 2 regions
3 = scarring involving 3 regions
4 = generalised reduction in cortical mass
Intervention: DMSA at least 3 months after UTI
MCUG at least 6 weeks after UTI
Presence and severity of scarring
Number with reflux
The prevalence of VUR was 39% (45% in males and 25% in females) and the prevalence of scarring was 23% (28% in males and 11% in females). Two children had a solitary functioning kidney. VUR was demonstrated in 55 renal units.
There was a significant relationship between the degree of scarring and the grade of VUR (p<0.05). When renal units were categorised by sex, a significant dependency relationship was seen between the degree of scarring and the grade of VUR for boys (p<0.05) but this was not shown to be significant for girls.
Honkinen O;Jahnukainen T;Mertsola J;Eskola J;Ruuskanen O; 2000 Jul 52Study Type: Case-series - population surveillance data
Evidence Level: 3
To assess the clinical characteristics of bacteraemic UTI in children134 children with serious bacteremic UTI located from all 36 Finish hospitals and 25 microbiological laboratories, between 1985 and 1994
Comparison group 134 age and sex matched from children hospitilised for blood culture negative symptomatic UTI
Children aged 7 days to 9.5 years (median 0.125 years) with serious bacteremic UTI.
Inclusion criteria were symptoms of acute illness such as fever, irritability, vomiting or dysuria; bacterial growth ≥105 in one midstream urine or in two urine bag samples; growth of identical pathogen both in the blood and in the urine cultures; first known urinary tract infection; and no known urinary tract abnormality or other severe underlying disease.
29 children had a history of UTI or urinary tract abnormality or other severe underlying disease. 7 children were under 1 week old and analysed separately
Results from imaging studies were available for 132 (98%) of bacteraemic children and all 134 controls.
Of the bacteraemic children
112 renal ultrasounds
123 voiding or radionuclide cystourethrograms
77 IVPs
Of non bacteraemic children
134 renal ultrasounds
128 voiding or radionuclide cystourethrograms
18 IVPs
Age and sex distribution of bacteremic UTI
Symptoms and signs
laboratory findings
microbiological findings
Number with VUR
Age and Sex distribution:
61% boys, 39% girls
Age range 7 days to 9.5 years (median 0.125 years)
66% were 1 week to 3 months of age (69% of youngest age group were boys, this male dominance decreased with age)
22% 3 to 11 months
12% ≥ 12 months
Annual incidence in Finland of bacteremic UTI in children <16 years of age and without previous UTI infection or underlying disease during the study period was 1.5/100000.
Results reported bacteremia patients vs. nonbacteremic patients
Symptoms
Fever 124 (92%) v 121 (90%)
The duration of the preceding fever (mean, 1.9 ± 1.9 vs. 1.8 ± 1.7 days) was not different between groups.
Irritability 81 (60%) v 75 (56%)
Abnormal crying 46 (34%) v 41 (30%)
Vomiting 22 (16%) v 18 (13%)
Lethargy 35 (26%)v 41 (30%)
Feeding problems 27 (20%) v 13 (10%) p = 0.02
Abdominal pain 10 (7%) v 4 (3%)
Dysuria 2 (1%) v 4 (3%)
Convulsions 5 (4%) v 0 (0%)
Laboratory findings
White blood cell count
18.2 ± 7.4 x 109/l (n = 127) vs.19.1 ± 8.2 x 109/l (n = 133) NS
Mean CRP on admission
116 ± 67 mg/l (n = 134) vs. 76 ± 56 mg/l (n = 132) p < 0.01.
Hyponatremia (sodium concentration ≤ 130 mmol/l) occurred in 9/81 (11%) bacteremic patients and 4/65 (6%) on nonbacteremic patients
No differences were found in the mean sodium, potassium or creatinine concentrations
Microbiological findings
E. coli
114/134 (85%) vs. 125/134 (93%) of the blood culture negative UTIs (p = 0.04).
Staphylococcus aureus caused 6 bacteremic infections and 1 nonbacteremic infection.
Imaging studies
(results available from 132/134 (98%) of bacteremic patients and 134/134 control patients).
Urinary tract abnormalities
51% vs. 46%
Grade 3–5 vesicoureteral reflux
40 (30%) vs. 22 (16%)
Urinary obstruction
12 (9%) vs. 2 (1%) (p < 0.01).
Imaging results of 113/114 children with bacteremic urinar infection caused by E.coli. were available. 52/113 (46%) had a urinary tract abnormality
10/113 (9%) later underwent urinary tract surgery.
Imaging results of 19/20 children with bacteremic urinary infection caused by bacteria other then E.coli. were available. 17/19 (89%) had a urinary tract abnormality (p < 0.01 when compared to E-coil infections). All of the patients with Staphylococcus aureus, Klebsiella or Enterococcus faecalis had a urinary tract abnormality. 14/19 (74%) later underwent urinary tract surgery (p < 0.01 when compared to E-coil infections).
Imaging results of all 124 children with nonbacteremic urinary infection caused by E.coli. were available. 55/124 (44%) had a urinary tract abnormality and 14/124 (11%) later underwent urinary tract surgery.
Imaging results of all 10 children with nonbacteremic urinary infection caused by bacteria other then E.coli. were available. 7/10 (70%) had a urinary tract abnormality (p < 0.19 when compared to E-coil infections). 4/10 (40%) later underwent urinary tract surgery (p = 0.03 when compared to E-coil infections).
Neonates
The 7 children < 1 weeks were not enrolled in the comparative analysis.
5 boys and 2 girls.
Mean CRP on 1st day 118 mg/l (range 23 to 256 mg/l)
Mean WBC 12.2 x 109/l (range 3.7 to 22.9 x 109/l
1/7 was afebrile
3/7 had normal urinary imaging, 2/7 were operated on for urinary obstruction and 1/7 was operated on for grade 4 reflux and 1/7 had grade 2 reflux.
Some of the Children included in this study may have been included in the study 240
Honkinen O;Lehtonen OP;Ruuskanen O;Huovinen P;Mertsola J; 1999 Mar 20 240Study Type: Case-series
Evidence level: 3
To determine whether an association exists between the bacterial species causing first UTI and abnormal findings in subsequent imaging studies.1237 Children with positive urine samples.All children presenting to a hospital with positive urine culture from a sample obtained by SPA (any growth) or catherisation (growth of at least 10000 colony forming unit/ml) between January 1980 to December 1994.
Excluded: asymptomatic children, who had been in hospital for more tham 2 day, chronic urinary problems such as neurogenic bladder or no imaging studies were lacking.
Intervention: Children with UTI infection underwent:
IVP (1980–1983)
Ultrasonography (1984–1994) and VCUG (radiographic in boys, nuclear in girls) one to two months after the acute infection.
Comparison: Children with first-time UTI caused by E.coli compared to children whose first-time UTI was caused by Proteus, Klebsiella, Enterococcus or Coagulase negative staphylococcus
Outcome Measures:
Microbiological results
Imaging results
Of the 1237 children with positive urine samples 922 (76%) were obtained by surpapubic aspiration and 295 (24%) by bladder catherisation.
Microbiological results:
Bacteria cultures were positive for:
E.coli 982/1237 (79%)
Enteroccus sp. 66/1237 (5.3%)
Klebsiella sp. 55/1237 (4.4%)
Coagulase negative staphylococcus 47/1237 (3.8%)
Proteus sp. 39/1237 (3.2%)
Other species 48/1237 (3.9%)
Age and sex matched children whose UTI were caused by E.coli. were compared to children who’s UTI was caused by another bacteria:
Mean C-reactive protein (mg/l) was the same in the children infected with micro organisms other than E.coil compared with those infected with E. coil. Apart from the children infected with Proteus who had lower mean C-reactive protein levels (23 ± 24 vs. 69 ± 47 mg/l, p < 0.001).
Reflux was more common in children infected with Klebsiella and Enterococcus than E-coil (Klebsiella 16/26 vs. 30/92, p < 0.01 and Enterococcus 16/26 vs. 30/92, p < 0.01) but less common in Proteus compared to E. coli. (2/26 vs. 30/92, p < 0.05), and the rate in coagulase negative staphylococcus was no different than E. coil.
Operation or injection therapy for reflux was more comment in children infected with Klebsiella, Enterococcus and coagulase negative staphylococcus than E-coil (Klebsiella 10/26 vs. 7/92, p < 0.001, Enterococcus 12/26 vs. 7/92, p < 0.001, and coagulase negative staphylococcus 5/14 vs. 7/92, p < 0.01), and the rate in Proteus was no different than E. coil.
Obstruction was more comment in children infected with Klebsiella, Enterococcus and coagulase negative staphylococcus than E-coil (Klebsiella 4/26 vs. 1/92, p < 0.01, Enterococcus 3/26 vs. 1/92, p < 0.01, and coagulase negative staphylococcus 2/14 vs. 1/92, p < 0.05). There were no cased of obstruction in children infected with Proteus.
The rate of other abnormalities was not different between the children infected with different microorganisms.
Some of the Children included in this study may have been included in the study Ref ID 996
Sargent MA;Stringer DA; 1995 May 241Study Type: Case-series
Evidence Level: 3
To determine if the frequency of VUR in children referred by paediatric nephrologists and paediatric urologists was different from the frequency observed in children referred by adult urologists, paediatricians and family practitioners.309 children (192 girls, 117 boys)Children (aged 1 week - 15 years), having their first VCUG following their first UTI between 1992 and 1993.
Exclusions: Children with known VUR, neuropathic bladder, renal or other abnormalities.
Intervention: VCUGPresence or absence of VUR.Overall 35/117 (30%) of boys had VUR and 56/192 (29%) of girls had VUR.
Children under 1 year
Males 19/56 (34%)
Females 19/41 (46%)
Children under 2 years
Males 23/77 (30%)
Females 25/57 (44%)
Children aged 2–4 years
Males 6/19 (32%)
Females 20/63 (32%)
Children over 5 years
Males 6/21 (29%)
Females 11/72 (15%)
Messi G;Peratoner L;Paduano L;Marchi AG; 1988 50Study Type: Case-series
Evidence Level: 3
To present clinical and laboratory features of UTI and to determine incidence of UTI223 children (38 males, 185 females)Children aged 0–14 years presenting with symptomatic UTI and treated at a hospital. 64 infants >1 year, 63 children 1–4 years, 96 children 5–14 years.
UTI was defined as two consecutive urine cultures yielding 105 or more cfu/ml of the same bacteria and microscopic examination yielding more then 10 leukocytes/mm3.
VCUGNumber with UTI
Number with cystitis
Number with pyelonephritis
Number with VUR
Renal scarring
Urinary tract malformations
Symptoms and signs
Fever 144/223 (64.6%)
Dysuria and frequency 92/223 (41.2%)
Gastrointestinal symptoms 42/223 (18.8%)
Haematuria 24/223 (10.8%)
Failure to thrive 14/223 (6.3%)
Jaundice 2/223 (0.9%)
Incidence
For cystitis, the total incidence per 1000 0–14 year old children in females was 1.08, in males 0.28 and overall 0.67. For pyelonephritis, the total incidence per 1000 0–14 year old children in females was 1.28, in males 0.18 and overall 0.71.
Overall, the rate of UTI per 1000 0–14 year old children in females was 2.36, in males 0.46 and overall 1.38.
The incidence of VUR per 1000 0–14 year old children in females was 0.41, in males 0.10 and overall 0.25.50
The distribution of cystitis and pyelonephritis was different between boys and girls. In boys aged less than one year, 4 had cystitis compared to 11 girls and 11 boys had pyelonephritis compared to 38 girls. In boys and girls aged 1 year to 14 years old, 42 boys had cystitis compared to 159 girls and 19 boys had pyelonephritis compared to 162 girls.
The incidence of reflux in children with UTI per 1000 children less than one year old was 1.79 in boys and 4.30 in girls. In children between one and four years old the incidence was 0.13 in boys and 0.47 in girls. In children between 5 and 14 years old the incidence was 0.20 in girls and there were no cases for boys.
Jodal U; 1987 Dec 47Study Type: Case-series
Evidence Level: 3
Study 1
Aims unclear
Study 2
To survey the frequency of bacteriuria in an unselected infant population and to study the interrelation between asymptomatic and symptomatic bacteriuria
1177 children with first time symptomatic UTI (952 girls and 225 boys)Children aged under ten years with first time symptomatic UTI.
Bacteriuria definition: At least 105 bacteria per ml together with leukocyturia in a midstream sample or bag sample. Any growth on SPA
Pyelonephritis definition: Bacteriuria and fever of <38.5°C and a microsedimentation rate of ≥25mm per hour or CRP ≥20mg/L
Cystitis definition: acute voiding symptoms (dysuria, frequency) with temperature <38.5°C and normal laboratory findings.
A child with acute symptoms and bacteriuria that could not be classified was said to have 'unspecified UTI'
Outcome measures:
No. with reflux (and grade)
No. with scarring
No. of symptomatic recurrences
No. with pyelonephritis/cystitis
Study 1
225/1177 (19%) boys
952/1177 (81%) girls
Boys
133/225 (59%) of UTIs detected in the first year of life
72/225 (33%) had VUR
8/72 (11%) dilated reflux (grade ≥3)
41/225 (18%) had one recurrence
11/225 (5%) had 2 or more recurrences
Girls
181/952 (19%) of UTIs detected in the first year of life
315/952 (34%) had VUR (54% between 1–3 years)
25/315 (8%) dilated reflux (grade ≥3)
152/952 (16%) had one recurrence
152/952 (16%) had 2 or more recurrences
Scarring
15/278 (5%) children with no reflux had scarring
3/29 (10%) of children with grade 1 reflux had scarring
17/99 (17%) of children with grade 2 reflux had scarring
25/38 (66%) children with grade ≥3 reflux had scarring
25% of the total number of children with scarring did not have reflux.
Pyelonephritis
7/141 (5%) children with 0 pyelonephritis episode had scarring
32/366 (9%) of children with 1 pyelonephritis episode had scarring
15/98 (15%) of children with 2 pyelonephritis episode had scarring
12/35 (35%) of children with 3 pyelonephritis episode had scarring
14/24 (58%) children with ≥4 pyelonephritis episode had scarring
Study 2
All girls with asymptomatic bacteriuria were left untreated:
Of 3581 newborns in the study population, 94% entered the study and 68% had all three tests at ages two weeks, three months and ten months.
Screening bacteriuria (asymptomatic)
Girls 0.9%
Boys 2.5%
Symptomatic UTI
Girls 1.1%
Boys 1.2%
89/90 infants with bacteriuria had IVU
85/90 had VCUG
Reflux
Asymptomatic bacteriuria 5/46 (11%) had grades 1 or 2 reflux.
Symptomatic UTI 14/39 (36%) had reflux
Abnormalities
Asymptomatic bacteriuria
Symptomatic UTI 5/39 (13%), 1 child had agenesis of one kidney, one had marked pelvoureteric stenosis and 3 had dilated reflux.
Clearing of bacteriuria
11 girls with asymptomatic bacteriuria were left untreated and of these 10 (91%) became abacteriuric within 7 months of detection. 34/36 boys were left untreated and within 11 months 27 (79%) became abacteriuric.
McKerrow W;vidson-Lamb N;Jones PF; 1984 Aug 4 66Study Type: Case-series
Evidence Level: 3
To report the results of investigation and treatment over a five to fifteen year follow up.Intervention: IVU performed in 550/572 (96%)
MCUG performed in 386 where there was suspicion of bladder abnormality.
572 children (399 girls, 173 boys)Children aged under 13 years with a history of at least one confirmed urinary tract infection who had been referred by their family doctor to a paediatric surgical outpatient clinicNumber with abnormalities572 children with UTI
Abnormalities found in 51% of children with UTI.
6% had scarred kidneys with no evidence of reflux
31% had reflux (24% of ureters)
7.5% had obstructions
48% had cyctourethritis
7% had duplex kidneys
0.9% had deformities
Of the ureters with reflux:
53% were initially treated medically, in 84% of these the reflux ceased
53% were operated on, resulting in no further problems in 65%. Late problems developed in 38% of children aged under 5 years and 12% of children aged over 5 years at diagnosis with ureters that had reflux and kidneys showing reflux nephropathy, treated surgically. The problems included repeat operation to correct reflux, nephrectomy because of deteriorating function, ureterosomy, hypertension and renal failure.
Bacteriuria not defined
Not all children had an IVU, however the number who did not have one was small.
Pylkkanen J;Vilska J;Koskimies O; 1981 80Study Type: Case-series
Evidence Level: 3
To identify patients at high risk of renal damage following UTI252 infants and children with first time UTI (271 entered study, 10 moved away and 9 subjects did not comply)Children aged 6 to 24 months
UTI defined as: Any bacterial growth from SPA, or 105cfu/ml in 2 consecutive clean-voided urine samples.
Pyelonephritis defined as: Rectal temperature ≥39.0C, ESR ≥35mm/h, CRP ≥20ug/ml, decreased renal concentrating capacity (determined by the DDAVP test).
Lower tract infection: 2 or less criteria fulfilled
Degree of renal parenchyma reduction:
Grade 1 - a minor shift of the renal outline
Grade 2 - a distinct parenchymal reduction
Grade 3 - an almost complete loss of parenchyma corresponding to a deformed calyx group
IVU to detect renal scarring (performed 2 weeks after the initiation of antibiotic therapy)
IVU was repeated at 2 years.
MCUG to detect VUR (performed 2–4 weeks after the IVU on patients with suspicion of distending reflux or obstruction at the 14 day check-up).
Number with UTI
Number with abnormalities
Number with VUR
19/271 (9%) loss to follow-up
164/252 (65%) children had upper UTI
88/252 (35%) children had lower UTI or asymptomatic UTI
Abnormalities
26/252 (10%) of all children with UTI had abnormalities (reflux, pelveureteral stenosis, nonobstructive hydronephritis, papilloma of the urinary bladder, ureterocele and sarcoma botryoides of the urinary bladder)
23/164 (14%) of children with upper UTI had abnormalities compared to 3/88 (3%) of children with lower UTI or asymptomatic bacteriuria (p<0.025)
Reflux
(7.9%) 20/252 of all children with UTI had reflux, 3 bilateral and 17 unilateral.
12/252 of all children with UTI (5%) had scarring, and all had upper UTI
8/20 with reflux (40%) had scaring.
In children without distending reflux, obstruction of the urinary tract or sarcoma botryoides, 66/237 (28%) had recurrence of UTI in first year and 82/237 (35%) in the first 2 year).
34/237 (14%) had 3rd infection (10/34 (29%) had abnormality)
Lindberg U;Claesson I;Hanson LA;Jodal U; 1975 May 242Study Type: Case-series
Evidence Level: 3
Evaluate the roentgenological findings and relation to pyuria, sedimentation rate, CRP, concentrating capacity and history of earlier infections.116 schoolgirls with asymptomatic bacteriuria116 school girls aged 7 to 16 referred to Paediatric Department for further investigation because of at least two positive urine tests detected at urinary screening during 1971–1972 and who presented to the hospital with no symptoms.
Positive urine test: more than 105cf/ml of the same organism in two consecutive samples.
Degree of parenchymal reduction was categorised as:
1 = minor shift of the renal outline
2 = distinct parenchymal reduction
3 = almost complete reduction of parenchyma corresponding to a deformed calys group.
IVP
MCUG
Number with reflux
Number with scarring
Intervention: IVP
MCUG
Overall 24/116 (20.7%) with reflux.
11/12 girls with calyceal changes and parenchymal reduction suggestive of previous pyelonephritis had reflux
A further 13/104 (11.2%) girls with normal IVPs had reflux.
The mean degree of reflux did not differ between the groups with and without parenchymal changes. Five girls had a double collection system (4.3%) and a diverticulum of the urinary bladder was found in 3 girls (2.6%).
Kunin CM; 1970 Nov 243Study Type: Case-series
Evidence Level: 3
Reports clinical, bacteriologic and urologic characteristics of the cases detected from population screening.156 girls identified with persistent bacteriuria10 year epidemiological study form 1959 to 1969 identified girls with persistent significant bacteriuria.
Significant bacteriuria 3 or more consecutive urine cultures containing 105 cfu/ml of the same species or serotype of E. coli.
Recurrent bacteriuria - reappearance of significant bacteriuria after lowering bacterial counts to ≥1000/ml or within 1 week of completion of therapy.
Intervention: History taking
Physical exam
IVP
Cystogram
Comparison: n/a
Number with reflux
Number with scarring
Reflux: Total 26/137 (18.9%)
Of Caucasian girls (n = 115)
Age 5–9: 13/37 (35.1%)
10–14: 8/52 (15.3%)
Repair of reflux in 7/26 (27%) girls
Follow up cystograms conduced in 16/19 (84%) of the girls who did not have reflux repaired
Reflux disappeared in 11/16 (69%)
Upper age limit not reported.
Data only extracted for age groups that were clearly defined.

From: Evidence tables

Cover of Urinary Tract Infection in Children
Urinary Tract Infection in Children: Diagnosis, Treatment and Long-term Management.
NICE Clinical Guidelines, No. 54.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2007 Aug.
Copyright © 2007, National Collaborating Centre for Women’s and Children’s Health.

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