• Journal of Yeungnam Medical Science
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• v.33 no.2
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• pp.105-111
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• 2016

Background: Neutropenic fever is one of the most common and potentially severe complications of chemotherapy in pediatric oncology patients, while urinary tract infection (UTI) is one of the most prevalent bacterial infections in these patients. Therefore, this study was conducted to investigate features of UTI with neutropenic fever in pediatric oncology patients. Methods: We retrospectively reviewed and analyzed the medical records, laboratory results and image findings of cases of neutropenic fever in the Department of Pediatrics of Yeungnam University Medical Center, South Korea between November 2013 and May 2015. Episodes were divided into two groups, UTI vs. non-UTI group according to the results of urine culture. The results were then compared between groups. The analysis was performed using IBM SPSS 23.0. A p-value <0.05 was considered to indicate a significant difference between groups. Results: Overall, 112 episodes of neutropenic fever were analyzed, among which 22 episodes (19.6%) showed organisms on urine culture and were classified as UTI. The remaining 90 episodes were classified as non-UTI. Only four episodes (18.2%) of the UTI group showed pyuria on urine analysis. In the UTI group, 76.5% were sensitive to the first line antibiotics and showed higher clinical response than the non-UTI group. Among hematologic malignancy patients, the UTI group revealed higher serum ${\beta}2$-microglobulin levels than the non-UTI group ($1.56{\pm}0.43mg/L$ vs. $1.2{\pm}0.43mg/L$, p<0.028). Conclusion: UTI in pediatric neutropenic fever responds well to antibiotics. Hematologic malignancy cases with UTI reveal increased serum ${\beta}2$-microglobulin level. These results will be helpful to early phase diagnosis of UTI.

• Childhood Kidney Diseases
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• v.21 no.2
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• pp.136-141
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• 2017

Purpose: This study aimed to investigate clinical and radiological factors that may predict high-grade vesicoureteral reflux (VUR) in patients with febrile urinary tract infection (UTI). Methods: We retrospectively analyzed medical records of 446 patients diagnosed with febrile UTI from March 2008 to February 2017. All patients underwent renal-bladder ultrasonography (RBUS), 99mTc dimercaptosuccinic acid (DMSA) renal scan, and voiding cystourethrography (VCUG), and were divided in to 3 groups: a high-grade VUR group (n=53), a low-grade VUR group (n=28), and a group without VUR (n=365). Results: The recurrence and non-Escherichia coli infection rates in febrile UTI were significantly higher in the high-grade VUR group than in the other two groups (P<0.05). RBUS showed that hydronephrosis and ureter dilatation were more frequent in the high-grade VUR group than in the other groups (P<0.05). In the high-grade VUR group, a renal cortical defect was more likely to appear as multiple defects, and the difference in bilateral renal scan uptake between both kidneys was larger than in the other two groups (P<0.001). Conclusion: Recurrent UTI, non-E. coli UTI, abnormal findings on RBUS such as hydronephrosis and ureter dilatation, and abnormal findings in the DMSA renal scan such as multiple renal cortical defects and greater uptake difference were associated with high-grade VUR. VCUG should be selectively performed when RBUS and/or DMSA renal scan reveal significant abnormalities.

• Childhood Kidney Diseases
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• v.14 no.1
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• pp.71-78
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• 2010

Purpose : Hydronephrosis is found about 30% of children with urinary tract infection (UTI). It can be caused by various conditions, although most childhood hydronephrosis is congenital. This study was performed to investigate the relationship between febrile UTI and hydronephrosis. Methods : We retrospectively reviewed the medical charts of 183 patients diagnosed as UTI between January 2007 and May 2009 at Korea University Guro Hospital. Inclusion criteria were as followings; 1) fever more than $37.5^{\circ}C$ measured in the axilla, 2) positive urine culture, 3) no history of urinary tract anomaly on antenatal sonography and urinary tract infection. We classified the enrolled children into two groups of patients with hydronephrosis (HN) and those without hydronephrosis (NHN). Results : The 80 patients were HN and 103 patients NHN. Hydronephrosis was found in 58 patients with left kidney, 8 right and 14 both kidneys. Most of hydronephrosis were of low grade. Compared with NHN group, initial renal cortical defects on DMSA scan significantly increased in HN group (HN 37.5%, NHN 16.5%, P<0.05). The incidence of VUR was not different between the two groups (HN 22%, NHN 12.1%). White blood cell counts and C-reactive protein were not different between the two groups. Follow-up DMSA scan (about 6 months later after UTI) showed no difference of renal scarring in both two groups. Conclusion : Our data suggests that hydronephrosis in febrile UTI patients is clinically useful for detecting renal cortical defects, but is not associated with follow-up renal scar.

• Childhood Kidney Diseases
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• v.20 no.2
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• pp.69-73
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• 2016

Purpose: The aim of this study was to compare the clinical and laboratory features of infants with roseola infantum due to human herpesvirus 6 (HHV6) infection and those with urinary tract infection (UTI). Methods: We retrospectively reviewed the medical records of children who were hospitalized at Cheil General Hospital and Women's Health Care Center, College of Medicine, Dankook University, and diagnosed as having HHV6 infection or UTI. Results: Among the infants admitted between September 2014 and May 2016, 92 (male, 45 and female, 47) were included in the study and divided into a HHV6 infection group (n=50) and a UTI group (n=42). The relative risk of UTI compared with that of HHV6 infection increased with pyuria (P<0.001), increased with leukocytosis (mean white blood cell [WBC] count, $15,048{\pm}5,756/mm^3$ vs $87,916{\pm}54,056/mm^3$; P<0.001), increased with C-reactive protein (CRP) level ($4.89{\pm}4.85 mg/dL$ vs $1.04{\pm}1.76mg/dL$; P<0.001), and younger age ($6.3{\pm}3.2months$ vs $18.3{\pm}12.6months$; P<0.001). The relative risk of HHV6 infection compared with that of UTI increased with fever duration ($4.3{\pm}1.7days$ vs $2.8{\pm}1.7days$; P<0.001) and decreased with platelet (PLT) count ($373{\pm}94{\times}10^3/mm^3$ vs $229{\pm}90{\times}10^3/mm^3$; P<0.001). No significant differences were found between the HHV6 groups according to the presence or absence of pyuria. Conclusion: Pyuria, age, fever duration, WBC count, CRP level, and PLT count were the differentiating factors of HHV6 infection from UTI. However, sterile pyuria can occur in children with HHV6 infection. In the presence of pyuria, CRP level and PLT count were the strong predictors of UTI compared with HHV6.

• Clinical and Experimental Pediatrics
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• v.58 no.9
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• pp.341-346
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• 2015

Purpose: To evaluate the practical applications of the diagnosis algorithms recommended by the American Academy of Pediatrics urinary tract infection (UTI) guideline. Methods: We retrospectively reviewed the medical records of febrile UTI patients aged between 2 and 24 months. The patients were divided into 3 groups: group I (patients with positive urine culture and urinalysis findings), group II (those with positive urine culture but negative urinalysis findings), and group III (those with negative urine culture but positive urinalysis findings). Clinical, laboratory, and imaging results were analyzed and compared between the groups. Results: A total of 300 children were enrolled. The serum C-reactive protein level was lower in children in group II than in those in groups I and III (P<0.05). Children in group I showed a higher frequency of hydronephrosis than those in groups II and III (P<0.05). However, the frequencies of acute pyelonephritis (APN), vesicoureteral reflux (VUR), renal scar, and UTI recurrence were not different between the groups. In group I, recurrence of UTI and presence of APN were associated with the incidence of VUR (recurrence vs. no recurrence: 40% vs.11.4%; APN vs. no APN: 23.3% vs. 9.2%; P<0.05). The incidence of VUR and APN was not related to the presence of hydronephrosis. Conclusion: UTI in febrile children cannot be ruled out solely on the basis of positive urinalysis or urine culture findings. Recurrence of UTI and presence of APN may be reasonable indicators of the presence of VUR.

• The Journal of Internal Korean Medicine
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• v.21 no.4
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• pp.683-686
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• 2000

Vesicoureteral reflux(VUR) is a state that urine regurge from bladder to ureter and kidney because of congenital, structural, functional abnormality of ureterovesical junction and lower urinary tract than bladder. It may be the primary cause of recurrent urinary tract infection(UTI) in chindhood, If urine regurge with UTI, it can cause renal damage, leading to scar formation, hypertension, chronic renal failure, But upper complications can be prevented by early diagnosis and proper treatment of VUR and UTI, so clinician must focus on them in treatment of VUR. We had experienced a case of recurrent UTI with VUR regardless of consistent antibiotics therapy in 7 years old boy, Chief complain was urinary frequency, The symptom of urinary frequency was successfully treated by herb medicine(Gamijihwag-tang), So, we report this case with a brief review of related literatures.

• Childhood Kidney Diseases
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• v.5 no.2
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• pp.176-181
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• 2001

Purpose : Urinary tract infection is a common problem in children. To evaluate for reflux most authorities recommend a voiding cystourethrogram 3 to 6 weeks after the first urinary tract infection. But during the 3 to 6 weeks interval, patients may fail to show up for the scheduled VCUG and thus risk for loss of follow up. We analyzed patient's records to evaluate whether the timing of VCUG after UTI influenced the prevalence or severity of VUR. Methods : We retrospectively reviewed 213 children diagnosed with UTI from March 1997 to December 2000. These children were divided into 2 groups according to whether they had VCUG scheduled to be performed either within 1 weeks after the diagnosis of UTI (Group A) or later than 1 week after the diagnosis(Group B). We compared tile presence and severity of reflux in the 2 groups. Results : Reflux was present in $19\%$ of the patients studied within 1 week after UTI and in $18\%$ of those studied after 1 week. This difference was not statistically significant. Whereas $100\%$ of the scheduled VCUGs in the Group A were performed, only $48\%$ of those scheduled in the Group B were performed. This difference is statistically significant. Conclusion : Because there was no significant difference between the presence or severity of reflux and timing of VCUG after UTI, we suggest that a hospitalized patient with UTI should have VCUG performed before discharge. (J. Korean Sor Pediatr Nephrol 2001 ;5 : 176-81)

• Childhood Kidney Diseases
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• v.5 no.1
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• pp.30-35
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• 2001

Purpose : To evaluate tile frequency of urinary tract anomalies in male neonates less than 3 months old who presented with urinary tract infection(UTI) and to evaluate a appropriate imaging approach after first UTI. Materials and methods : During a period of 5 years from March 1994 to February 1999, 65 male infants less than 3months old(range: 4-92 days, mean: 43 days) with UTI were evaluated. Ultrasound(US) and Voiding cystourethrogram(VCUG) were done in 60 patients. Due to refusal and technological problem, 5 patients were missed. 99mTc-dimercaptosuccinic acid renal scan (99mTc-DMSA renal scan) was recommended to most patients but performed in 40 patients. Renal scan was performed at least 3 months later after urinary tract infection. Results : Urinary tract anomalies were found in 26 of 65 infants. Twenty-six had vesicoureteral reflux(VUR), two had both VUR and double ureter, two had both U and posterior urethral valve. In patients with VUR, eight had renal scar or renal atrophies. In case of renal scar or atrophy, grades of VUR were III or above. Conclusion : We suggest that US and VCUG should be routinely performed in infants(<3months)with first UTI. 99mTc-DMSA renal scan should be performed only when renal parenchymal damage was observed in US and VUR grade III or above in VCUG. (J. Korean Soc Pediatr Nephrol 5 : 30- 5, 2001)

• Childhood Kidney Diseases
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• v.24 no.2
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• pp.83-90
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• 2020

Purpose: To investigate the association between urinary neutrophil gelatinase-associated lipocalin (uNGAL) and leukocyte differential count in children with urinary tract infections (UTIs). Methods: A retrospective chart review was performed in children undergoing uNGAL measurements between June 2018 and September 2019. Patients with suspected or diagnosed UTIs were included. The relationship between uNGAL and blood leukocyte differential count was investigated in children. Results: A total of 197 children were included in this study, 119 of whom (60%) had UTIs. The non-UTI patients (n=78) were diagnosed with pneumonia, acute gastroenteritis, viral upper respiratory infection, and others. After adjusting for age, gender, and fever duration, the leukocyte count, monocyte count, and uNGAL levels were higher in the UTI group than in the non-UTI group (P<0.05). uNGAL showed positive correlations with neutrophil counts, monocyte counts, the neutrophil-to-lymphocyte ratio, and the monocyte-to-lymphocyte ratio in the UTI group (P<0.05). uNGAL levels were only associated with the neutrophil-to-lymphocyte ratio in the non-UTI group (P<0.05). In a multivariable logistic regression analysis, only uNGAL was associated with the presence of UTI (P<0.05). The area under the receiver operating characteristic curves for uNGAL and monocyte counts to identify UTI were 0.89 (95% confidence interval (CI): 0.824-0.939; P=0.025) and 0.7 (95% CI: 0.627-0.774; P=0.038), respectively. Conclusions: In children with UTIs, uNGAL levels may be associated with blood leukocyte differential counts. uNGAL measurements and monocyte counts can be helpful in children with suspected UTIs.

• Pediatric Infection and Vaccine
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• v.17 no.2
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• pp.67-73
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• 2010

Purpose : We aimed to compare the clinical features and antibiotic resistance of urinary tract infection (UTI) caused by pathogens other than E. coli (non-E. coli) with UTI caused by E. coli in children. Methods : We enrolled patients with culture-proven UTI, who were admitted to the study hospital from September 2008 to August 2009. We investigated clinical data of patients with UTI and antibiotic resistance of isolated strains. For comparison, patients were divided according by results of the urine culture into E. coli and non-E. coli UTI groups. Results : A total of 84 patients participated in this study. Twenty one cases (25.0%) were caused by non-E. coli pathogens. Frequency of non-E. coli UTI differed according to age and sex: 'male <6 months', 10.5%; 'male ${\geq}$6 months', 50.0%; 'female <6 months', 43.7%; and 'female ${\geq}$6 months', 25.0% (P=0.014). More patients who received previous antibiotic treatment (P=0.017), but fewer patients who showed hematuria (P=0.014) were included in the non-E. coli UTI group than in the E. coli UTI group. Comparison of antibiotic resistance showed that the non-E. coli UTI group possessed more strains that were resistant to cefazolin, cefotaxime, imipenem, trimethoprim/sulfamethoxazole (TMP/SMZ) and tetracycline than the E. coli UTI group (P<0.05). Conclusion : Increased incidence, different distribution by age and sex, and high antibiotic resistance of non-E. coli UTI should be considered in selection of empirical antibiotics for treatment of UTI in children.