Analysis Of Risk Factors For Predicting Vesicoureteral Reflux In Children With Urinary Tract Infection

Research background: Urinary tract infections(UTI)is the most common bacterial infections in childhood.At the same time,UTI is closely associated with vesicoureteral reflux(VUR).VUR is the abnormal reflux of urine from the bladder to the kidneys.VUR can cause kidney scarring,hypertension and even renal failure.Therefore,the early diagnosis of VUR is particularly important.The diagnosis of VUR requires the examination of excretory urography(VCUG).However,due to various reasons such as radioactivity and invasiveness,VCUG is performed unconventionality in children with UTI.There is no ideal diagnostic protocol for VUR after UTI.Purpose:By analyzing and comparing the clinical features in UTI children,we investigated the risk factors that might predict VUR with UTI.Methods: A total of 79 children with UTI admitted to the inpatient Department of Pediatric nephrology,Anhui Children’s Hospital from January 2019 to June2022 were selected.Children with UTI were divided into two parts: first UTI and recurrent UTI.According to the results of VCUG examination,first UTI was divided into VUR group and no VUR group,and the VUR group could be divided into IV-V VUR group and I-III VUR group;recurrent UTI was divided into IV-V grades VUR group and no or I-III grades VUR group.Clinical data such as sex,age,blood test data,urine culture results and imaging results were compared and analyzed.Results:(1)First UTI:There was no significant difference in age < 1 year(X2=0.122,P = 0.727),sex(X2= 0.000,P = 1.000)and male infants(X2= 0.000,P =1.000)between the VUR group and the no VUR group.There was no significant difference in PCT(Z =-1.035,P =0.301)and CRP(Z =-0.595,P =0.552)between VUR group and no VUR group.There was a statistically significant difference in urine culture of non-E.coli between the groups(X2= 3.901,P =0.048).There was no significant difference in renal pelvis separation(< 10mm)(X2= 0.000,P = 1.000)、renal volume abnormalities(X2= 0.000,P = 1.000)and repeated kidney(X2= 1.088,P = 0.297)between groups.The difference in ureteral dilation(X2= 4.000,P = 0.046)and hydronephrosis(X2= 4.000,P =0.046)between the groups was statistically significant.In first UTI,there was no significant difference between grade IV-V VUR group and no or grade I-III VUR group in urinary culture of non-E.coli(X2= 0.000,P = 1.000).The difference of ureteral dilation(X2= 15.672,P = 1.000)and hydronephrosis(X2=7.853,P = 0.005)between groups was statistically significant.(2)Recurrent UTI: There was a statistically significant difference between grade IV-V VUR group and no or grade I-III VUR group in urinary culture of non-E.coli(X2= 12.507,P = 0.000).There was no significant difference in renal pelvis separation(< 10mm)(X2= 0.000,P = 1.000)and renal volume abnormalities(X2= 0.000,P = 1.000)between groups.The difference in ureteral dilation(X2= 7.150,P = 0.007)and hydronephrosis(X2= 4.354,P = 0.037)between the groups was statistically significant.Conclusion:(1)VUR tests should be considered when RBUS results indicate hydronephrosis or ureter dilation,and non-E.coli pathogen in urine culture with first UTI,especially when RBUS results suggest hydronephrosis and ureter dilation.(2)It is suggested that the patient has grade IV-V VUR when there is any of the clinical auxiliary findings of hydronephrosis,ureter dilation,or non-E.coli pathogen in urine culture with recurrent UTI,and VCUG should be recommended.