Association of Urinary Tract Abnormalities in Children with First Urinary Tract Infection

Background: Urinary Tract Infections (UTI) may be a variety of presentation of underlying urinary tract abnormalities including vesicoureteral reflex (VUR), obstructive uropathy, urolithiasis, and ureteral duplication. The long-term complications of UTI with these conditions are renal scarring, hypertension, and chronic renal failure. Objective: The aim of this study was to determine the incidence of urinary tract anomalies associated with first UTI. Methodology: We reviewed 158 patients (aged one month to 15 years) who were hospitalized with symptomatic UTI during a 2-year period (2001-2003). Patients with incomplete investigations were excluded from the study. One hundred twenty six patients (100 girls and 26 boys) were included in the study. Ninety-seven (77%) were under 5 years. Confirmed cases of UTI underwent renal and urinary tract ultrasonography (US), voiding cystourethrography (VCUG) ,and 99mTcdimercaptosuccinc acid (DMSA) scan. Results: The most common presentation were fever (83%) and dysuria (48%). The commonest causative agent was E coli (88%). VUR was found in 50 (39.6%), 39 girls, and 11 boys. Other urinary tract abnormalities were renal stone in 10 (8%) patients, pelvic ureteric junction obstruction in 8 (6.3%), neurogenic bladder in two boys and one girl, double collecting system in 2 girls, posterior urethral valves in two boys and ureterocele in one girl, respectively. Conclusion: Forty percent of patients had VUR and 20% had other associated abnormalities in urinary tract. We recommend that US, VCUG and DMSA scan should be routinely performed on all patients after the first UTI.