Vesicoureteral Reflux in Hospitalized Children with Urinary Tract Infection：The Clinical Value of Pelvic Ectasia on Renal Ultrasound, Inflammatory Responses and Demographic Data

Background: The aims of this study were to determine whether renal pelvis dilation onultrasound was reliable in predicting vesicoureteral reflux (VUR) and toassess the relationship of other clinical information of VUR in children withurinary tract infection (UTI).Methods: We retrospectively reviewed clinical data, renal echo, and voiding cystourethrogram(VCUG) results in hospitalized children with their firstepisode of UTI, aged from 1 month to 5 years, during a 1-year period.Results: There were 114 children with 228 kidneys eligible for the study. Unilateralpelvis size greater than 8 mm had 2.4 ( p = 0.049, 95% CI: 1.0-5.9) and 3.7( p = 0.025, 95% CI: 1.2-11.3) times greater risk for VUR and severe reflux,respectively. The sensitivity in detecting severe reflux was 27.8%, and thespecificity was 90.5%. The positive and negative predictive values in suggestingsevere VUR were 20.0% and 93.6%, respectively. The sum of bilateralpelvis sizes greater than 16 mm had higher risk for VUR and severereflux (4.1 and 4.6 times) and similar specificity and negative predictivevalue for severe reflux. Age, gender, C-reactive protein, leukocytosis, pyuriaand acute pyelonephritis did not show significant relationships to the reflux.Conclusions: Unilateral pelvis size greater than 8 mm or the sum of the bilateral pelvissizes greater than 16 mm was associated with VUR, especially severe VUR.The possibility of severe reflux was lower than 10% when the reverse criteriawere applied. However, the dilation of the renal pelvis did not predict allVUR precisely. We concluded that VCUG should still be performed in hospitalizedchildren with UTI.