381 Contrast-enhanced urosonography in diagnostics of intrarenal reflux Article Swipe
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· 2021
· Open Access
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· DOI: https://doi.org/10.1136/archdischild-2021-europaediatrics.381
· OA: W3206976968
<h3></h3> Many studies have shown that intrarenal reflux (IRR) is one of the most important risk factors for febrile urinary tract infections (UTI) and renal scarring and consequently the development of hypertension and renal failure. The incidence of IRR diagnosed by fluoroscopic voiding cystourethrography (VCUG) ranges from below 1% to 10%. Although numerous studies have indicated high diagnostic accuracy of ceVUS compared to VCUG in the detection of VUR, a limited ability for detecting IRR in children compared to VCUG has been suggested as a potential drawback of ceVUS. The aim of our study is to evaluate the prevalence of IRR diagnosed by ceVUS and its association with age, gender and grade of VUR. We used LOGIQ S8 ultrasound machine equipped with dedicated software for contrast-enhanced studies and harmonic imaging (HI). Standard ultrasound of the urinary tract was followed by bladder catheterisation and instillation of physiological normal saline and the US contrast medium (SonoVue®, Bracco). The diagnostic criterion for IRR is the appearance of contrast microbubbles outside the contours of the duct system or renal calyx and the entry of contrast into the renal parenchyma. Since March 2006 until January 2020 we performed 8130 ceVUS examinations and found VUR in 2972 children (36,6%). Until December 2012 we did not use contrast specific software and we found VUR in 1013 out of 2977 children (34%) of whom IRR was found in 23 children (2,3%). Since January 2013 we used contrast specific software and HI and found VUR in 1959 out of 5153 children (38%) and IRR in 233 children (11,9%). We detected IRR in 124 male (53,2%) and 109 female patients (46,8%) with age range from 15 days to 82 months. Most common indications for ceVUS were: febrile urinary tract infection (82%), prenatally diagnosed hydronephrosis (14,6%) and neurogenic bladder (2,6%). Unilateral IRR was found in 180 patients (77,3%) and bilateral in 53 patients (22,7%). From all uretero-renal units with IRR (286), VUR was II grade in 8 children (2,8%), III grade in 41 (14,3%), IV grade in 174 (60,8%) and V grade in 63 children (22%). Our results in the largest so far published series of patients with ceVUS show that using contrast specific software and harmonic imaging intrarenal reflux was found in about 12% of patients with VUR. IRR is found even in children with low grade reflux. Our results emphasize the importance of considering IRR in the future classification of VUR as well as in assessment of prognosis and therapy in each child with VUR.
