Renal blood flow with ultrasonography and vesicoureteral reflux in childhood upper urinary tract infection

Abstract

We often experience difficulty diagnosing upper urinary tract infections in patients without pyuria or typical clinical features, because of antibiotics prescribed by other physicians. We sometimes encounter adult patients with reflux nephropathy or chronic renal failure who have never undergone investigation for vesicoureteral reflux. We always order an ultrasound for pyrexic patients lacking clinical features or without pyuria. Thus, we diagnose upper urinary tract infection based on a positive urine culture or a hypovascular renal lesion using ultrasound and advanced dynamic flow (ADF). In this study, we divided our patients into three groups based on urine culture findings and ultrasonographic findings (defined as having hypovascular lesions or not). The average age was significantly lower in the group with positive urine cultures and no hypovascular lesions than in the other two groups. Premedication with antibiotics was significantly more frequent in the group with negative urine cultures and hypovascular lesions than in the other two groups. The frequency of vesicoureteral reflux was significantly higher in groups with hypovascular lesions of the kidney than in group without hypovascular lesions. It is useful to evaluate renal blood flow with ultrasound and ADF when investigating the origin of a fever and estimating vesicoureteral reflux.