• Childhood Kidney Diseases
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• v.3 no.2
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• pp.187-195
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• 1999

Purpose : VUR is state where urine regurge from bladder to ureter and kidney. It is shown in about 1/3 of urinary tract infection patients and it is classified as grade I to V. We compared results from RI VCUG(Radiisotope voiding cystourethrography) and X-ray VCUG which used in diagnosing VUR in children, to evaluate which is better in diagnosing VUR in children. Methods : 41 Patients(19 males, 21 females), who visited Pediatric department, Soonchunhyang university Hospital from peroid of 1991. January to 1998. July for recurrent urinary tract infection or abnormalities in ultrasonogams, were enrolled in the study. The age ranged from 9 months to 17 years and mean age was 5 1/2 years. Both RI VCUG and X-ray VCUG were done and follow-up test of urine culture, renal ultrasonogram and RI VCUG were done every month, every 3 month and every 6 month, respectively to observe the disappearance of VUR and evaluated the prognosis. Results : 24 patients had taken RI VCUG and 17(70.1%) patients showed positive result. 22 patients had taken X-ray VCUG and 9(40.1%) patients showed findings of VUR. 17 patients had taken both tests and 14 patients showed positive result in RI VCUG and 6 of these patients also showed reflux in X-ray VCUG. 3 patients who showed negative in RI VCUG, showed negative also in X-ray VCUG. For prognosis, resolution and scar formation was shown in 8 patients each. Persistent VUR was shown in 6 patients and 2 of these patients VUR was corrected by operation, 1 patient showed decreased renal function, and 1 patient was not follwed up. 8 of 9 patients who showed findings of VUR on DMSA scan formed a scar and 8 patients who showed no findings of VUR didn't form a scar. Urine culture was positive in 17 of 19 patients with VUR. Positive rate in urine culture was higher than that of patients with no VUR who showed positivity in 15 of 21 patients for urine culture. E. coli was most common organism and the period free of UTI was 14 months in VUR patients and it was shorter compared to patients without VUR which was 26 months. Conclusion : In diagnosing VUR in children, the positive rate was higher in RI VCUG than X-ray VCUG. Therefore, in early diagnosis when VUR is suspicious but not shown in X-ray VCUG, RI VCUG should be done and it will help to make accurate diagnosis.

• Childhood Kidney Diseases
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• v.13 no.1
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• pp.33-39
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• 2009

Purpose : Our aim is to reduce the rate of lumbar spinal tapping and voiding cystourethrography (VCUG) in febrile urinary tract infection (UTI) infants less than 3 months of age. Methods : We reviewed the prevalence of UTI, sepsis, meningitis and UTI with bacterial meningitis in febrile infants less than 3 months of age during the period from Jan. 2001 to Jun. 2008. Renal ultrasonography, Technetium-99m dimercaptosuccinic acid (DMSA) renal scan or VCUG were performed in infants with UTI. Infants with UTI were divided into two groups according to the presence of abnormal findings of ultrasonography and DMSA renal scan : group 1-Infants in whom both ultrasonography and DMSA were normal, group 2-Infants in whom ultrasonography or DMSA were abnormal. Prevalence of VUR was compared between the two groups. We followed up the clinical course of patients who had VUR in group 1. Results : Among 1962 Infants, UTI, sepsis and bacterial meningitis were diagnosed in 620 (31.6%), 63 (3.2%), 8 (0.4%) respectively. Lumbar puncture was performed in 413 (66.6%) infants with UTI and we did not detect a case of bacterial meningitis in association. 348 infants with proven UTI were undergone ultrasonography, DMSA, VCUG. In group 1 with 110 infants (31.6%), the presence of VUR was 4 (3.6%). In group 2 with 238 infants (68.4%), the presence of VUR was 51 (21.4%). Abnormal findings of ultrasonography or DMSA renal scan were closely related with high grade VUR. Most of patients with VUR in group1 had good prognosis. Conclusion : Lumbar puncture and VCUG are invasive procedures. Therefore we should decide whether to perform lumbar puncture or VCUG in infants less than 3 months. of age with their first febrile UTI.

• Childhood Kidney Diseases
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• v.13 no.1
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• pp.40-48
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• 2009

Purpose : This study was performed to identify factors related to the resolution of primary vesicoureteral reflux (VUR) in infants. Methods : We reviewed 183 infants (M : F=149 : 34) diagnosed as urinary tract infection (UTI) between February 2002 and July 2007 at Sanggye Paik Hospital. The diagnosis of UTI was made by culture from a urine specimen obtained by suprapubic puncture (n=97), catheterization (n=83), or collection bag method (n=3, twice positive culture of same organism). All of the infants were performed renal ultrasonography, DMSA scan and voiding cystourethrography (VCUG) study. Follow-up imaging consisted of contrast VCUG or direct isotope VCUG at interval of 1 year. We evaluated the relationship of clinical and laboratory finding, radiologic finding in infants with VUR. Results : Among 51 VUR patients, 18 infants had grade I-II, 12 infants had grade III and the other 21 patients had grade IV-V. Abnormal findings including hydronephrosis on renal ultrasonography were not correlated with severity of VUR. However, the incidence of renal defect in the first DMSA scan showed a tendency of direct correlation with severity of VUR in female patients only (P<0.001). There was significant difference of resolution rate in three VUR groups (grade I-II, III, IV-V) in male patients only (P=0.025). Resolution rate was higher for male patients with unilateral VUR than bilateral (P<0.001). But unilaterality had not any affect on VUR resolution in female VUR patients (P=0.786). Resolution rate was higher for VUR patients without renal scar than VUR patients with renal scar (P<0.001). Conclusion : According to our findings, grade of VUR, laterality and renal scar are the factors that contribute to resolution of primary VUR in male and female infants differently.

• Childhood Kidney Diseases
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• v.11 no.2
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• pp.220-228
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• 2007

Purpose : We studied the value of clinical signs, laboratory findings and $^{99m}technetium$ dime-rcaptosuccinic acid(DMSA) scan in predicting the presence of vesicoureteral reflux(VUR) in children with first febrile urinary tract infection(UTI). Methods : A retrospective analysis of 84 hospitalized children with first febrile UTI was performed. They underwent DMSA scan and voiding cystourethrography(VCUG) during the acute phase, and were divided into three groups according to the results of the VCUG: absence of VUR, mild(grade I-II) and severe VUR(grade III-V). We studied the relation of VUR to age, gender, fever duration, causative organism, white blood cell count, serum C-reactive protein and result of DMSA scan. Results : Among 84 patients, 6 had mild and 17 had severe VUR. Thirty-eight had abnormal DMSA scan. results Patients with VUR were older than those without VUR(P<0.01). There was a lower probability of infection with Escherichia coli in patients with severe VUR than in those with mild and absent VUR(P<0.01). An abnormal DMSA scan correlated with the presence and severity of VUR(P<0.05). Severe VUR was present in 10.9% of patients with normal DMSA scan. The sensitivity, specificity, positive and negative predictive values of the DMSA scan in predicting the presence of VUR were 69.6%, 63.9%, 42.1%, and 84.8%, respectively. Conclusion : An abnormal DMSA scan correlated to the presence and severity of VUR, but the sensitivity, specificity and positive predictive value of the DMSA scan were low. There-fore, patient with an abnormal DMSA scan requires a VCUG. In order to prevent missing the 10.9% of patients with severe VUR but normal DMSA scans, a VCUG should be performed in patient with normal DMSA scan.

• Childhood Kidney Diseases
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• v.11 no.2
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• pp.203-211
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• 2007

Purpose : We attempted to compare the independent factors such as age, sex, C-reactive protein(CRP), and white blood cell count(WBC) in children with radiologic studies and assess the necessity of performing voiding cystourethrography(VCUG). Method : 98 children who have been diagnosed their first time febrile urinary tract infection from Janurary 2002 to Januray 2005 were enrolled. In all patient, the duration of fever which occurred before and after treatment was recorded, and CRP, WBC, $^{99m}Tc$-2,3-dimercaptosuccinic acid($^{99m}Tc$-DMSA) renal scans, renal ultrasound and VCUG were analyzed. Results : Of the 98 children diagnosed with urinary tract infection(UTI), 52 were male and 46 were female. 18 had abnormalities in VCUG, 17 had abnormalities in kidney ultrasound, and 20 had partial defects or diffuse uptake decrease in $^{99m}Tc$-DMSA renal scans. There were no significant relationship between incidence of radiologic abnormalities and age. The risk of renal scar was significantly higher in children who had a longer febrile period before treatment than in those with shorter period. Both CRP and WBC were significantly elevated in children with the radiological abnormalities. A positive of $^{99m}Tc$-DMSA renal scans and renal ultrasound were highly associated with vesicoureteral reflux(VUR). Conclusion : If there are abnormalities in the kidney ultrasound and $^{99m}Tc$-DMSA renal scan of a child with initial UTI, a VCUG is recommended. Even in cases without abnormal findings in $^{99m}Tc$-DMSA renal scan and renal ultrasound, clinical data such as CRP and WBC should be assessed, and VCUG should be Performed for the undetected VUR.

• Childhood Kidney Diseases
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• v.12 no.1
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• pp.62-69
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• 2008

Purpose: The most concerning issue in children with urinary tract infection(UTI) is the probability of underlying genitourinary anomalies and vesicoureteral reflux (VUR), which is frequently associated with renal scarring and eventually end-stage renal disease. Therefore, voiding cystourethrography(VCUG) is usually recommended at the earliest convenient time for children with UTI. However, VCUG is an invasive procedure that requires catheterization and exposure to X-ray. In this study, we aimed to determine the predictability of clinical, laboratory and imaging parameters for VUR in children with UTI. Methods: Data of children with bacteriologically proven UTI who underwent VCUG were evaluated retrospectively for clinical(age, gender, fever), laboratory(leukocytosis, ESR, CRP, pyuria, blood urea nitrogen, serum creatinine) and imaging(renal ultrasound and DMSA renal scan) findings. First, children with UTI were divided into two groups according to the presence of VUR as non-VUR group and with VUR group, and clinical, laboratory variables were compared between these groups. Second, patients who had VUR were reclassified as low-grade VUR(grade I-II) group and high-grade(grade III-V) VUR group according to grading of VUR, and clinical, laboratory and imaging variables were compared between these groups. Results: Among 410 children with UTI, 137 had VUR and 78 high-grade VUR. Fever, leukocytosis, ESR, CRP, pyuria were associated with VUR. In addition, abnormal findings of ultrasonography and DMSA renal scan were closely related to VUR. However, these clinical and laboratory variable in patients with high grade VUR were not different significantly, compared to those with low-grade VUR group. Conclusion: Fever, leukocytosis, ESR, CRP seems to be potentially useful predictors of VUR in pediatric patients with UTI. In addition, renal ultrasonography and DMSA renal scan findings supported the presence of VUR. Further study of these findings could limit unnecessary VCUG in patients with UTI.

• Journal of the Korean Society of Radiology
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• v.9 no.7
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• pp.529-533
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• 2015

VCUG(Voiding Cystourethrography) study is being performed to check urinary reflex symptom from bladder to ureter or kidney in the method of filling the bladder with radiation opaque contrast agent. However, VCUG study have been performed impersonally, patients have to be naked and open their legs and then void. This method is so impersonal that it is immediately needed to improve the way of testing and crete new aid. Therefore, this study through producing underwear for VCUG, analysis and compares the test time of VCUG, patient radiation dose and patient satisfaction. The target of this study was 79 Male and Female patients who visited genitourinary clinic of PNUYH for their VCUG tests AXIUM Iconos R200(Siemens Medical System : Germany) and self-produced plastic underwears made by vinyl and plasic molding machine were used. The 79 patient were divided into two groups : experiment of patient and comparison group of we patient (using aid) in order to compare, testing time, DAP (dose area product) and patient satisfaction. There was time reduction, from 35.3min of comparison group to 27.8min experimentation group by 7.5min decrease. And comparison group of $4566.6{\mu}Gym^2$(DAP) decreased experimental group (using aid) of $3411.9{\mu}Gym^2$ by $1154.7{\mu}Gym^2$. In the case of patients satisfaction study, anxiety had a drop by 3.45 of comparison group to 2.51 experimentation group by 0.94 decrease. in experimental group. And shame had a drop by 4.02 of comparison group to 3.08 experimentation group by 0.94 increase. in experimental group. Difference of the smooth voiding had a drop by 1.90 of comparison group to 2.84 experimentation group by 0.94 increase. in experimental group. In addition satisfaction had a rise by 1.19 in experimental group. There were also other opinions of uncomfortableness on it and troublesome to wear. VCUG is one of the sensitive care required test. Therefore staff and the aid can give patients such comfortable and the aid can consentive on voiding. As a result test time and DAP can be reduced. It is needed to make testing at more comfortable for patients.

• Childhood Kidney Diseases
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• v.4 no.1
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• pp.57-62
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• 2000

Purpose: Unilateral ureteropelvic junction obstruction with high grade of hydronephrosis an obstructed diuretic renogram but good differential renal function were studied to evaluate the natural history of untreated obstruction. Materials and Methods: During the last three years, we encountered 18 kidneys with hydronephrosis detected on prenatal ultrasound. In all these patients other urologic abnormalities were excluded by voiding cystourethrography and other radiological studies. Diuretic renography was initially performed at an age ranging from 2 weeks to 4 weeks. Five had high degree of hydronephrosis and obstructed diuretic renogram despite good relative renal function. Periodic urine examination, ultrasonography and diuretic renogram were done at regular intervals. Results: We have followed 5 neonates with unilateral hydronephrosis and suspected ureteropelvic junction obstruction with noroperative treatment for 15 months. During followup, percentage and relative renal function were maintained in all patients and hydronephrosis improved. Obstructive patterns on diuretic renogram were variable. Conclusions: These findings help to define the natural history of untreated good functioning hydronephrotic kidneys. Many newborn kidneys with severe hydronephrosis are not obstructed despite even high grade of hydronephrosis and obstructed diuretic renogram.

• Childhood Kidney Diseases
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• v.10 no.2
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• pp.201-212
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• 2006

Purpose : Vesicoureteral reflux(VUR) is the major risk factor of urinary tract infection(UTI) in children and may result in serious complications such as renal scarring and chronic renal failure. The purpose of this study was to evaluate the relationship between VUR and renal scar formation, the usefulness and correlation of various imaging studies in reflux nephropathy, and the spontaneous resolution of VUR. Methods : We retrospectively reviewed 106 patients with VUR with no accompanying urogenital anomalies in the Department of Pediatrics, Bundang CHA Hospital during the period from Jan. 1996 to Mar. 2005. Ultrasonography and $^{99m}Tc$-dimercaptosuccinic acid(DMSA) scan were performed in the acute period of UTI. Voiding cystourethrography(VCUG) was performed 1 to 3 weeks after treatment with UTI. Follow-up DMSA scan was performed 4 to 6 months after treatment and a follow-up VCUG was performed every 12 months. Results : The mean age at detection of VUR was $13.8{\pm}22.2$ months and the male to female ratio was 2:1. The incidence of renal scarring showed a tendency of direct correlation between severity of VUR(P<0.001) and abnormal findings of renal ultrasonography(P<0.01). 63.2%(24 of 38 renal units) of renal parenchymal defects present in the first DMSA scan disappeared on follow-up DMSA scans. Follow-up DMSA scans detected renal scars in 7(14%) of 50 renal units with ultrasonographically normal kidneys. Meanwhile, ultrasonography did not show parenchymal defects in 7(36.8%) of 19 renal units where renal scarring was demonstrated on a follow-up DMSA scan. The spontaneous resolution rate of VUR was higher(75%) in cases with low grade(I to III) VUR(P<0.01). Conclusions : The presence and severity of VUR and abnormal findings of renal ultrasonography significantly correlated with renal scar formation. DMSA scan was useful in the diagnosis of renal defects. Meanwhile renal ultrasonography was an inadequate method for evaluating renal parenchymal damage. Therefore, follow-up DMSA scans should be performed to detect renal scars even in children with low-grade VUR and normal renal ultrasonography.

• Clinical and Experimental Pediatrics
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• v.53 no.2
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• pp.222-227
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• 2010

Purpose : To evaluate the significance of clinical signs and laboratory findings as predictors of renal parenchymal lesions and vesicoureteral reflux (VUR) in childhood urinary tract infection (UTI). Methods : From July 2005 to July 2008, 180 patients admitted with a first febrile UTI at the Pediatric Department of Konkuk University Hospital were included in this study. The following were the clinical variables: leukocytosis, elevated C-reactive protein (CRP), positive urine nitrite, positive urine culture, and fever duration both before and after treatment. We evaluated the relationships between clinical variables and dimercaptosuccinic acid (DMSA) scan and voiding cystourethrography (VCUG) results. Results : VCUG was performed in 148 patients; of them, 37 (25.0%) had VUR: 18 (12.2%) had low-grade (I-II) VUR, and 19 (10.5%) had high-grade (III-V) VUR. Of the 95 patients who underwent DMSA scanning, 29 (30.5%) had cortical defects, of which 21 (63.6%) had VUR: 10 (30.3%), low-grade (I-II) VUR; and 11 (33.3%), high-grade VUR. Of the 57 patients who were normal on DMSA scan, 8 (14.0%) had low-grade VUR and 6 (10.5%) had high-grade VUR. The sensitivity, specificity, and positive and negative predictive values of the DMSA scan in predicting high-grade VUR were 64.7%, 69.9%, 33.3%, and 89.5%, respectively. Leukocytosis, elevated CRP, and prolonged fever ($36{\geq}$ hours) after treatment were significantly correlated with the cortical defects on DMSA scans and high-grade VUR. Conclusion : Clinical signs, including prolonged fever after treatment, elevated CRP, and leukocytosis, are positive predictors of acute pyelonephritis and high-grade VUR.