Ultrasonographic findings in the kidney and urinary tract in children with vesicoureteral reflux

Abstract

Objective: To identify the epidemiological and ultrasonographic characteristics of different degrees of vesicoureteral reflux (VUR) detected by voiding cystourethrography (VCUG).

Material and methods: We performed a retrospective study which evaluated the US and VCUG in 279 children (554 kidneys) under 18 years with suspected VUR at the National Institute of Child Health from July to December 2009. The US findings to VUR were considered the pelvic and ureteral dilatation, the thickening of the urothelium and bladder wall, while for kidney damage were decreased renal size and thickness of the renal parenchyma, increased echogenicity renal parenchyma and corticomedullary dedifferentiation. VUR was classified according to the International System of Grading of VUR into five grades. The data were analyzed based on frequencies and percentages.

Results: The VUR predominance in females (54.05%) and age between 6 months and 6 years (64.86%). Only 27 children (51 kidneys) had VUR. The pelvic dilatation was more frequent ultrasonographic criteria (52.94%) for VUR, while the decrease in kidney size was for kidney damage (52.94%). All of US findings evaluated were predominant in severe grades of VUR (IV and V). However, there were patients with normal US despite having severe grades of reflux. Polycystic kidney disease (21.43%) was the most common congenital anomaly. The 17.64% of the patients with VUR is associated with other abnormalities.

Conclusions: VUR is more common in females. The ultrasound can detect the most severe degrees of VUR and the presence of kidney damage, however, a normal ultrasound does not exclude it. In addition ultrasound helps identify other abnormalities that may or may not be associated with VUR.