Comparison of clinical, laboratory and imaging methods of patients with recurrent urinary tract infections

Introduction-Purpose: Vesicoureteral reflux (VUR) refers to the escape back of urine from the bladder into ureters due to insufficient ureterovesical disorders. It during urination is one of the most common diseases of pediatric nephrology and pediatric surgery units. On average, 35% of children diagnosed with recurrent urinary tract infection have VUR. Every child with proven urinary tract infection should be investigated for VUR. VUR may be associated with congenital anomaly, infection, anatomical and functional reasons. VUR is a major cause of morbidity and mortality in children such as hypertension, growth retardation, renal failure. Urinary tract infection is most commonly associated with VUR pathology. Nowadays, radiological examination which is accepted as the gold standard for the initial diagnosis of VUR is voiding cystourethrogram (VCUG). The aim of this retrospective study was; evaluation of clinical, laboratory and imaging methods in recurrent urinary tract infections, determine the frequency of vesicoureteral reflux by imaging methods, and to diagnose, treat and follow-up. Material and Methods: The study was designed retrospective study. A total of 135 patients under 19 years of age with recurrent UTI who were admitted between January 2013 and December 2018 at Düzce University Faculty of Medicine Hospital Department of Pediatrics were included in the study within the framework of designated exclusion criteria. Demographic information, age, weight, gender, additional disease, laboratory and imaging results, treatment follow-up information were obtained. Findings: Of the 135 patients included in the study, 98 (72.6%) were female and 37 (27.4%) were male. Female patients were 7.5 ± 4.4 years and male patients were 5.2 ± 4.4 years old. When the frequency of bacterial growth in culture was examined, the frequency of E. coli in 71 (72.4%) girls was significantly higher (p <0.001). The incidence of anemia was significantly higher in 60 (44.4%) patients with VUR than those without VUR (P <0.006). In patients with VUR + compared to voiding, unilateral pathology frequency was higher in DMSA and MAG-3 imaging (p values 0.003 and 0.023, respectively). Results: In our study, 43 of 60 patients (71.66%) and 17 of them (28.34%) were male. 134 patients underwent DMSA scintigraphy, 35 (26.1%) unilateral and 7 (5.2%) bilateral scar tissue were detected. Our unvestigation results showed that, it was found that DMSA scintigraphy is a very sensitive diagnostic method for detecting renal damage in children with recurrent urinary tract infection. VCUG is necessary to detect VUR in patients with risk factors for renal scarring. The widespread use of DMSA scintigraphy and VCUG in this patient group will reveal new approaches and algorithms for the development of follow-up strategies in children with recurrent urinary infections.