Abstract
Purpose
There are no guidelines, what recommend pro or against CEVUS or VCUG for identification of VUR for adults who suffer from first episode of pyelonephritis. The aim of this study was to look at incidence of VUR in adults with first episode of pyelonephritis, and to highlight the necessity for recommending an investigation into reflux among these patients.
Methods
Retrospective study of all patients who admitted at our department in the past decade with the working diagnosis of pyelonephritis. Following discharge from the department, individuals with no pre-existing urological history were advised to undergo a VCUG or CEVUS to identify VUR.
Results
We have identified 76 patients (62 females and 14 males) with an average age of 31.73 years. 48(63%) presented with right pyelonephritis, 26(34%) with left and 2(3%) had bilateral disease. Of those, 23(30%) patients returned for clinical follow-up after completion of VCUG/CEVUS. Reflux was demonstrated in 14 (60%) patients comprising 18 renal refluxing units (RRU). 6 had grade IV reflux, 4 grade III, 4 grade II and 4 grade I respectively. DMSA demonstrated 27.2%±11.9% relative function of the reflux kidney. Of those VUR patients, 9 (64%) underwent endoscopic correction, one (7%) refused surgery and 4 (29%) are under clinical follow-up.
Conclusions
Our data demonstrate high incidence of VUR in these patients, therefore VUR investigation at least should be considered in adult patients even after first episode of pyelonephritis, especially in cases where there is evidence of nephronia, abscess, kidney scars, atrophic kidney or hydronephrosis.