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PEDIATRICS Vol. 113 No. 3 March 2004, pp. 548-550

Utility of Follow-up Renal Sonography in Children With Vesicoureteral Reflux and Normal Initial Sonogram

Lisa H. Lowe, MD*, Manish N. Patel, DO*, John M. Gatti, MD{ddagger} and Uri S. Alon, MD§

* Department of Radiology, Children’s Mercy Hospital and University of Missouri, Kansas City, Missouri
{ddagger} Department of Pediatric Urologic Surgery, Children’s Mercy Hospital and University of Missouri, Kansas City, Missouri
§ Department of Nephrology, Children’s Mercy Hospital and University of Missouri, Kansas City, Missouri

Objective. The purpose of this study was to determine the value of follow-up renal sonography in children who presented with urinary tract infection and were found to have a voiding cystogram diagnosis of vesicoureteral reflux while having a normal initial renal sonogram.

Methods. We retrospectively reviewed the medical records of 64 consecutive children who presented for follow-up renal sonography with a voiding cystogram diagnosis of vesicoureteral reflux and a normal initial sonogram conducted as part of the routine evaluation after urinary tract infection. Data recorded included gender, age, initial grade of reflux, time to follow-up sonogram, and abnormalities on follow-up sonogram. Children with conditions that may predispose to vesicoureteral reflux were excluded.

Results. Children who were studied (7 boys, 57 girls) ranged in age from 1 month to 10 years, 10 months (mean: 35.6 months; median: 24 months). Ninety-four (73.4%) of 128 renal units demonstrated vesicoureteral reflux on voiding cystogram; 89 (94.7%) of 94 of them were grade 1 to 3. The mean time to follow-up was 22 months (range: 4 months to 5 years, 2 months; median: 18 months). All 128 (95% confidence interval: 0%–2.8%) renal units were normal on follow-up sonography.

Conclusion. Routine performance of repeat sonography seems unnecessary among children, particularly girls, with low- to medium-grade vesicoureteral reflux, who have had a previous normal sonogram and no conditions that predispose to vesicoureteral reflux.

Key Words: vesicoureteral reflux • sonography • urinary tract infection • kidneys • prophylactic antimicrobials

Received for publication Dec 6, 2002; Accepted Jul 14, 2003.




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