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Predictors of grade 3–5 vesicoureteral reflux in infants ≤ 2 months of age with pyelonephritis

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Abstract

Background

This study aimed to assess predictors for grade 3–5 vesicoureteral reflux (VUR) in infants ≤ 2 months of age admitted for first urinary tract infection (UTI).

Methods

Retrospective cohort study of 195 infants ≤ 2 months admitted to a pediatric ward for first UTI between 2006 and 2017. Clinical, laboratory, and imaging data were collected from electronic medical charts. We examined associations between grade 3–5 VUR and different patient characteristics.

Results

Twenty infants (10%) were diagnosed with grade 3–5 VUR; all had fever. Infants with grade 3–5 VUR had higher blood neutrophil percentage (BNP) (65% vs. 46%, P < 0.001), higher neutrophil-to-lymphocyte ratio (NLR) (2.6 vs. 1.3, P < 0.001), more renal ultrasound abnormalities (prenatal 26% vs. 5%, P = 0.007; postnatal 84% vs. 55%, P = 0.015), and Pseudomonas UTI (15% vs. 1%, respectively, P < 0.001). NLR > 1.65 showed sensitivity 100% and specificity 61% for detecting grade 3–5 VUR. BNP > 53% showed sensitivity 100% and specificity 60% for detecting grade 3–5 VUR. BNP was the best single marker for grade 3–5 VUR with area under the curve (AUC) of 0.82 (95% CI 0.75–0.89). In a multivariate model, AUC for combination of BNP and hydronephrosis was 0.86 (95% CI 0.79–0.93, P = 0.007).

Conclusions

Infants ≤ 2 months of age admitted for a first UTI are at risk for grade 3–5 VUR and thus should undergo a voiding cystourethrography (VCUG) if their renal ultrasound is abnormal or if they have Pseudomonas UTI. Avoiding VCUG can be considered in afebrile infants and in infants with BNP < 53% or NLR < 1.65.

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Authors and Affiliations

  1. Department of Pediatrics, Assaf Harofeh Medical Center, 70300, Zerifin, Israel

    Hilla Bahat, Mai Ben-Ari, Ilan Youngster & Michael Goldman

  2. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Hilla Bahat, Tomer Ziv-Baran, Amos Neheman, Ilan Youngster & Michael Goldman

  3. Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Tomer Ziv-Baran

  4. Department of Urology, Assaf Harofeh Medical Center, Zerifin, Israel

    Amos Neheman

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  1. Hilla Bahat
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  2. Mai Ben-Ari
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Correspondence to Hilla Bahat.

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The study was approved by the institutional Research Ethics Board, waiving the need for informed consent.

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Bahat, H., Ben-Ari, M., Ziv-Baran, T. et al. Predictors of grade 3–5 vesicoureteral reflux in infants ≤ 2 months of age with pyelonephritis. Pediatr Nephrol 34, 907–915 (2019). https://doi.org/10.1007/s00467-018-4167-0

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  • DOI: https://doi.org/10.1007/s00467-018-4167-0

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