The Relationship between Urinary Tract Infection and Vesicourethral Reflux in Children from Eastern Galilee Region

Introduction: Urinary tract infection(UTI) is the most common bacterial infection among children. Upper UTI involves renal parenchyma and can cause scar tissue formation in the kidney that may lead to hypertension and renal function insufficiency.

Vesicourtereral reflux waspreviosly considered as a contributer to UTI incidence and thus to renal scaring. Therefore, Cystography, which is considered as the "gold standard" for reflux detection, was performed often in children despite exposure to radiation and inconvenient inherent in it.

Methods: This retrospective study was designed to determine whether cystography is a necessary part of upper UTI in children, by exploring the relationship between the presence of vesicourtereral reflux (reflux) and UTI.

The study enrolled 88 children, after verified UTI, who underwent cystography procedure. 69 of them also underwent DMSA mapping.

Results: About 40% of children after UTI were diagnosed with reflux by cystography.

Nearly 70% of children with pathologic DMSA mapping were diagnosed with reflux.

Moreover, children with reflux were also found to have elevated inflammation factors, comparing to those without reflux.

Conclusion: Based on our results, DMSA can become a Suitable replacement procedure to Cystography since it can detect renal scarring with good outcomes relative to cystography, and is much easier to perform on a child.

We can also conclude that reflux is associated with infection due to higher levels of inflammation factors (ESR, CRP) in correlation with reflux presence.

This study has a vast importance in the consolidation of protocols and guidelines regarding the procedures suitable for children after UTI.