Prenatally detected hydronephrosis: the incidence and diagnostics of vesicoureteral reflux and urinary tract infections

Sofia Visuri

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Sammanfattning

Hydronephrosis is one of the most common prenatally detected abnormalities. Our target was to study the incidence of VUR and urinary tract infection (UTI) in children with prenatally detected hydronephrosis. We investigated the incidence VUR and UTI in children with simple hydronephrosis, hydroureter, duplex collecting system or ureterocele We identified all the patients with diagnosis codes (ICD-10: Q60.0-Q64.9, N13.0 and N13.9) that suggested urinary tract disease or anomaly from our electronic patient record system. We included in the study patients who had an abnormal urinary tract ultrasound finding already during pregnancy and who had postnatally hydronephrosis (HN) and/or hydroureter, ureterocele or complicated duplex collecting system. All the information considering UTIs, imaging, laboratory results and clinical findings was explored manually. The incidence of UTI was compared to control patients who did not have abnormality that was supposed to expose to UTIs. Altogether 233 patients were included in the study: 135 of them had HN without VUR, 24 patients had grade IV-V VUR, 12 patients had grade 1-3 VUR, 21 patients had non-refluxing hydroureter, 34 patients had complicated duplex collecting system, and seven patients had single system associated ureterocele. Despite the use of prophylactic antibiotics, the risk of UTI was significantly increased only in patients with grade IV-V VUR, ureterocele and VUR, ureterocele or duplex system associated non-refluxing hydroureter (p = 0.001, p = 0.001, p = 0.012 and 0.010 compared to the controls). The VCUG-associated risk of UTI was between two and three percent. The incidence of UTI was only 14% after mini-invasive perforation of ureterocele. We also evaluated the sensitivity of renal ultrasound (RUS) examination in detecting grade IV-V VUR in patients with prenatally detected single system associated hydronephrosis or/and hydroureteronephrosis. According to multivariate analysis, only a visible ureter in RUS (OR 12.72; CI 5.33–32.04, p <0.001) and shorter length of kidney in standard deviation (SD) scale (SD 0 = 53 mm, 1 SD = 7 mm) (OR 2.67; CR 1.50–4.86, p <0.001) predicted grade IV-V VUR in our material. Visible ureter in RUS predicted also UTIs in multivariate analysis (OR 5.93; CI 2.83–12.30, p <0.001). On the basis on these findings, we created a three-grade risk scale where the renal units (RU) were scored based on the RUS findings. The incidence of grade IV-V VUR in RU was 2.9% in the low-risk group, 12.2% in the intermediate-risk group and 52.2% in the high-risk group. By using the scoring, 79% sensitivity and 82% specificity in detecting grade IV-V VUR was achieved. Additionally, we evaluated the usefulness of renal scintigraphy in diagnostics of VUR in our study. When a cut point of 44% differential renal function (DRF) in patient’s worse kidney was used, 73% of the patients with grade IV-V VUR were detected. Only 21% of the patients without VUR and 22% of the patients with grade 1-3 VUR had the corresponding reduction of DRF. The patients with prenatally detected HN and grade IV-V VUR, ureterocele or duplex collecting system in association with non-refluxing hydroureter had significantly increased risk of UTI despite the use of prophylactic antibiotics. A visible distal ureter in RUS and reduced longitudinal diameter of kidney in SD scale and DRF of <44% in patient’s worse kidney in renal scintigraphy are predictive of grade IV-V VUR. By using a risk scoring based on the RUS findings, the amount of unnecessary VCUGs can be reduced.
Originalspråkengelska
Handledare
  • Taskinen, Seppo, Handledare
  • Jahnukainen, Timo, Handledare
Tilldelningsdatum26 okt. 2018
UtgivningsortHelsinki
Förlag
Tryckta ISBN978-951-51-4466-9
Elektroniska ISBN978-951-51-4467-6
StatusPublicerad - 2018
MoE-publikationstypG5 Doktorsavhandling (artikel)

Bibliografisk information

M1 - 58 s. + liitteet

Vetenskapsgrenar

  • 3123 Kvinno- och barnsjukdomar
  • 3126 Kirurgi, anestesiologi, intensivvård, radiologi

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