Indication of voiding cystourethrography for infants with first urinary tract infection based on risk factors for high grade vesicoureteral reflux

Abstract

It has been said that the guideline of American Academy of Pediatrics regarding voiding cystourethrography (VCUG) indication has possibility to overlook high grade Vesicoureteral reflux (VUR). In this article, we conducted a multi-center prospective observational study to identify risk factors during acute phase period for high grade VUR (Grade 3–5, VUR≥3) in infants with first urinary tract infection (UTI). The results of univariate analysis showed that abnormality of renal bladder ultrasound (RBUS), high serum CRP level and high serum procalcitonin (PCT) level at admission were the risk factors relating to VUR≥3 (p<0.01). Furthermore, the result of multivariate analysis showed that serum PCT≥0.37 ng/ml is the single factor relating to the VUR≥3 (odds ratio 29.3, 95%CI; 3.7–236.0, p<0.01). In conclusion, first UTI infants with PCT≥0.37 ng/ml should undergo VCUG because they are at high risk to complicate high grade VUR.