Prevalence and Correlation of Radiological Abnormalities in Children with Urinary Tract Infection: A Cross-Sectional Study

Background: Urinary Tract Infection (UTI) is the most common serious bacterial infection in infancy and childhood. Identifying factors associated with its recurrence is crucial. This study aimed to determine the prevalence and correlation of abnormalities reported in urinary ultrasonography and other imaging studies in children hospitalized with UTI.Materials and Methods: This cross-sectional study was conducted on ۱۱۶ children under ۱۶ years of age diagnosed with UTI and admitted to Heshmatieh Hospital in Sabzevar in ۲۰۱۹. UTI was defined as the growth of ≥۱۰⁵ colony-forming units (CFU)/mL of a single uropathogen on urine culture, accompanied by pyuria (≥۵ white blood cells per high-power field) or clinical symptoms. Recurrent UTI was defined as ≥۲ episodes of febrile UTI or ≥۳ episodes of non-febrile UTI within ۱۲ months. After obtaining informed consent, demographic data, clinical presentation, urinalysis, urine culture results, and findings from renal and urinary tract imaging (Ultrasound, VCUG, and DMSA scan) were recorded. Median and interquartile range (IQR) were reported for skewed continuous variables. Proportions are presented with ۹۵% confidence intervals (CI). Data were analyzed using SPSS version ۲۰, with Chi-square and Fisher's exact tests employed for comparisons. Odds ratios (OR) with ۹۵% CI were calculated for significant associations.Results: The mean age was ۴۰.۴۵ ± ۴۸.۳۸ months (median: ۱۸.۰ months, IQR: ۶.۰–۶۰.۰), with ۷۵% (۹۵% CI: ۶۶.۲–۸۲.۴%) being female. The most common presenting symptom was fever (۵۶%, ۹۵% CI: ۴۶.۹–۶۴.۸%). E. coli (۴۶.۶% of all patients, ۹۵% CI: ۳۷.۵–۵۵.۹%; representing ۸۷.۱% of positive cultures) was the most frequently isolated pathogen. Radiological investigations revealed urinary stones in ۷.۸% (۹۵% CI: ۳.۸–۱۴.۰%), hydronephrosis in ۱۶.۴% (۹۵% CI: ۱۰.۴–۲۳.۹%), and vesicoureteral reflux (VUR) in ۵۷.۱% of those imaged (۹۵% CI: ۲۸.۹–۸۲.۳%) (with ۳۷.۵% Grade III and ۶۲.۵% Grade IV). Other structural anomalies were found in ۲۳.۳% (۹۵% CI: ۱۶.۱–۳۱.۹%). A significant correlation was observed between the presence of hydronephrosis (OR = ۵.۶۳, ۹۵% CI: ۱.۹۷–۱۶.۰۵, p=۰.۰۰۱), VUR (OR undefined due to zero events in non-recurrent group, p=۰.۰۲۴), and other structural abnormalities (OR = ۵.۴۳, ۹۵% CI: ۲.۱۷–۱۳.۵۸, p<۰.۰۰۱) with a history of recurrent UTI.Conclusion: A significant proportion of children with UTIs, particularly those with recurrent infections, have underlying structural and functional urinary tract abnormalities. Comprehensive renal and urinary tract imaging in these high-risk children is essential for timely identification and management to prevent recurrent infections and potential long-term complications.

کلیدواژه ها:

Child ، hydronephrosis ، Ultrasonography ، Urinary tract infection ، Vesicoureteral reflux