Color doppler sonography findings in paediatric patients with vesicoureteral reflux

Aim: The aim of this study was to evaluate the potential benefits of Color Doppler Ultrasonography (CDUS) parameters changes for reflux nephropathy and reflux followup of paediatric patients who suffer from vesicoureteral reflux (VUR). Materials and Methods: 106 patients (38 male, 68 female) diagnosed as VUR by voiding cystouretrography (VCUG) and 42 (19 male, 23 female) healthy volunteers were included in to study. All patients were investigated by urinary system ultrasonography before CDUS. Then patients were evaluated by CDUS. Interlobar arteries were localized from the upper, lower poles and middle zones of each kidney. The measurements of resistive index (RI), pulsatility index (PI) and acceleration time (accT) were obtained and the average values of this measurements were calculated. Similarly, both renal arteries were also studied for the parameters mentioned before. The patients who had reflux were compared with control group and who had unilateral VUR also compared with their normal kidneys. Also relation with RI values and reflux degree were evaluated. RI values were compared between the patients who had renal scarring proven by dimercaptosuccinic acid (DMSA) scintigraphy and patients who had no proven scars and with control group. By this way the act of CDUS in reflux follow-up, the relationship between the degree of reflux and presence of renal scar tried to put forward by doppler parameters. Findings: RI values were statistically significantly higher in the patient group when compared to control group. No difference was found in PI and accT values between two groups. When the patients who had unilateral VUR were compared with their normal kidneys, the RI and PI values were high significantly. RI values in high grade (grade V) reflux were significantly higher than low grade (grade I-III) reflux patients. In the reflux group who had scar were compared with reflux and no scar in DMSA, there was no statistically difference between each other in RI values. When the group of reflux with scar were compared with control group, RI values were founded too high as significantly. ROC curve analysis with scarring revealed that a discriminatory RI value of >0.705, with 85.7% sensitivity, 62.4% specificity for right kidney and >0.708, with 88.2% sensitivity, 58.1% specificity for left kidney for diagnosing renal scarring. Results: VUR can cause urinary infections, renal parenchymal damage and scar. So, early diagnosis and treatment of reflux is very important. We think that follow-up of RI values by using CDUS, which is a cheap, reproducible, without non-ionizing radiation can be helpful in reflux patients and renal scar. Key words: Vesicoureteral Reflux, Color Doppler Ultrasonography, Resistive Index.