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. 2024 Nov;113(11):2466-2472.
doi: 10.1111/apa.17353. Epub 2024 Jul 5.

Vesico-ureteral reflux diagnosis after initial kidney abscess: Results from a Paediatric Tertiary Hospital

Evgenia Preka  1   2 , Nicholas Miller  3 , Marina Avramescu  2 , Laureline Berteloot  4 , Nicolas Vinit  5 , Nathalie Botto  5 , Mathilde Grapin  2 , Maud Prévot  2 , Margaux Boistault  2 , Nicolas Garcelon  6 , Kiarash Taghavi  7   8 , Cécile Schrimpf  9 , Jérémie F Cohen  10 , Thomas Blanc  5 , Olivia Boyer  2
Affiliations

Vesico-ureteral reflux diagnosis after initial kidney abscess: Results from a Paediatric Tertiary Hospital

Evgenia Preka et al. Acta Paediatr. 2024 Nov.

Abstract

Aims: Guidelines regarding voiding cystourethrogram (VCUG) indications following a paediatric kidney abscess are lacking. This study evaluates vesicoureteral reflux (VUR) prevalence and outcome after a first kidney abscess.

Methods: This retrospective study included all children presenting to a tertiary paediatric reference centre with de-novo kidney abscesses from 2011 to 2022, diagnosed through imaging (ultrasonography or computed tomography). VCUG's clinical utility was assessed by exploring outcomes related to interventions.

Results: Among the 17 patients (median age 9 months, IQR; 6 months-6 years), VCUG identified VUR in 7 (41%; 95% CI: 18-65%), including two with grade IV-V. Median abscess size was 19 mm (IQR; 14-27). 7/8 (88%) children with DMSA scan presented scars, including 4 with hypofunctioning (20%-44%), and one with a non-functioning kidney. Scarring on the DMSA scan was similar regardless of identified VUR. Six children had subsequent pyelonephritis. Three of the remaining 11 had grade I-III and two IV-V VUR. Surgery was required in four children overall: three for recurrent pyelonephritis and one for high-grade VUR and scars.

Conclusion: Among initial kidney abscess cases, 41% had VUR, similar to children experiencing their first uncomplicated pyelonephritis. VCUG results guided antibiotic prophylaxis but not surgical decisions. We suggest considering VCUG following recurrent pyelonephritis/kidney abscess and/or kidney scarring.

Keywords: CAKUT; congenital or acquired anomalies of the urinary tract; paediatric; urinary tract infection; voiding cystourethrogram.

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References

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