PRIMARY VESICOURETERIC REFLUX IN CHILDREN BETWEEN 1 MONTH AND 12 YEARS WITH URINARY TRACT INFECTION ADMITTED IN A TERTIARY CARE HOSPITAL
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2013, Vol 2, Issue 14
Abstract
[b]OBJECTIVE[/b]: To determine the proportion of primary vesicoureteric reflux in children between 1 month and 12 years with urinary tract infection admitted in a tertiary care hospital. [b]METHODOLOGY[/b]: A Hospital based descriptive cross sectional study was conducted between May 2010 and October 2011 in the Department of pediatrics, Chennai Medical College Hospital, Trichy. Convenient sampling technique was applied to select the study subjects. Renal ultrasound and voiding cystourethrography (VCUG) examinations were performed in all confirmed cases of first UTI under 5 years of age and recurrent UTI at any age. Any children with underlying anatomic abnormalities of urinary tract or neurogenic abnormalities were excluded from the study. The severity of reflux expressed as a grade, which is based on the system established by the International Reflux Study in Children. The data was analyzed by proportions and chi – square test using SPSS statistical package version 11 at 95% confidence interval. P value <0.05 was considered significant. [b]RESULTS[/b]: First UTI commonly occurred under 2 years of age (54%). Recurrent UTI predominantly occurred beyond 2 years of age (70%).In less than 2 years age group the percentage of UTI was slightly higher in males(53%) than females(47%).After 2 years females had a higher percentage(64%) of UTI than males ( 36%).In first UTI under 2 years fever was the presenting complaint in 90% cases. In recurrent UTI fever was seen only in 28.5% cases. Common presentations of recurrent UTI under 2 years were irritability (64.3%), vomiting (42.8%), poor feeding (35%) and failure to thrive (35%).Common presentations of recurrent UTI in older children were specific urinary symptoms such as increased frequency (70%), dysuria (60%) and abdominal pain (45%).In first UTI only 22.5% cases were presented with VUR whereas in recurrent UTI 32% cases were presented with VUR. Grading of VUR in our study was Grade I 41%, Grade II 32%, Grade III 9%, Grade IV 9% and Grade V 9%. In first UTI severe Grades of VUR (> Grade 2) were not seen. The sensitivity and specificity of ultrasound in detecting VUR were 36.4% and 100% respectively. [b]CONCLUSION[/b]: Since the Vesicoureteric Reflux appears to be more common in the recurrent UTI, Voiding cystourethrogram (VCUG) is recommended in all the cases of recurrent UTI, so that prophylaxis can be entertained to prevent renal scarring and chronic glomerular insufficiency. Even in the first UTI, if the child is not shown improvement as expected, VCUG can be done. Since USG is safe noninvasive it is recommended in all confirmed cases of UTI.
Authors and Affiliations
Subbiah M, Jenitha B, Prabu Elango, Nagarajan C
Keywords
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