Prediction of high-grade vesicoureteral reflux in children younger than 2 years using renal sonography: A preliminary study

Objectives - To investigate the predictive value of renal sonography for vesicoureteral reflux (VUR) and the efficacy of renal sonography, technetium Tc 99m-labeled dimercaptosuccinic acid (DMSA) scanning, and a combination of the two for VUR screening in children younger than 2 years with a first episode of febrile urinary tract infection. Methods - Thirty-eight patients younger than 2 years with a first febrile urinary tract infection were included in our study, which was conducted from April through October 2014. Each kidney was considered a separate renal unit. A retrospective review of clinical information and images (renal sonography, DMSA scanning, and voiding cystourethrography) was performed. Results - Of the 14 renal units (18.4%) with VUR, 4 (28.5%) had high-grade VUR. Among single findings, dilatation of the renal collecting system, wall thickening of the renal collecting system, and DMSA scans significantly predicted VUR (P= .038, .027, and .01, respectively). Dilatation was the most common single finding (46 of 76 renal units). The sensitivity values for dilatation, wall thickening, and DMSA scans were 85.7%, 64.2%, and 50.0%, and the negative predictive values were 93.3%, 89.7%, and 87.9%. Conclusions - The negative predictive values indicate that normal renal sonographic and DMSA findings can predict the absence of high-grade VUR. We propose that renal sonographic findings of wall thickening as well as dilatation of the renal collecting system should be considered predictive of high-grade VUR.