ORIGINAL ARTICLE Predictors of renal scar in children with urinary infection and vesicoureteral reflux Alper Soylu & Belde Kasap Demir & Mehmet Türkmen & Özlem Bekem & Murat Saygı & Handan Çakmakçı & Salih Kavukçu Received: 29 October 2007 / Revised: 23 April 2008 / Accepted: 13 May 2008 / Published online: 9 July 2008 # IPNA 2008 AbstractWe evaluated the predictorsofrenalscarin children with urinary tract infections (UTIs) having primary vesicoureteral reflux (VUR).Data ofpatientswho were examined by dimercaptosuccinic acid (DMSA) scintigraphy between 1995 and 2005 were evaluated retrospectively. Gender, age,reflux grade, presence/development of scar- ring,breakthrough UTIs, and resolution of reflux,were recorded. The relation of gender, age and VUR grade to preformed scarring and the relation of gender, age,VUR grade,presence of preformed scarring, number of break- through UTIs and reflux resolution to new scarring were assessed. There were 138 patients [male/female (M/F) 53/ 85].Multivariate analysis showed that male gender [odds ratio (OR)2.5],age ≥27 months in girls (OR 4.2) and grades IV–V reflux (OR 12.4) were independent indicators of renal scarring. On the other hand, only the presence of previous renal scarring was found to be an independent indicator for the development of new renal scar (OR 13.4). In conclusion, while the most predictive variables for the presence of renal scarring among children presenting with a UTI were male gender, age ≥27 months in girls, and grades IV–V reflux,the best predictor of new scar formation was presence of previous renal scarring. Keywords Urinary tract infection . Vesicoureteral reflux . Renal scar Introduction Over the past few decades radiologic evaluation of urinary tractinfections (UTIs) has evolved considerably. The role of vesicoureteral reflux (VUR) as a predisposing factor for acquired renal scarring with pyelonephritic episodes has been questioned in recent years. The majority of the recen studies using dimercaptosuccinic acid (DMSA) scanning to detectearly pyelonephritic changes and subsequent renal scarsshowed a comparable risk for pyelonephritic scars between refluxing renal units and non-refluxing ones [ 1]. Formation of new renal scars has been stated to correlate better with recurrent UTIs than VUR, and to be even more prevalent in renalunitswithoutVUR [2]. Furthermore, neither the incidence of recurrent UTIs nor the progression of existing scars or development of new scars was affected by spontaneous resolution or surgical correction of reflux [3–5].These findings caused VUR to lose its image as a main factor for susceptibility to UTIs, to the point that,in the presence of normal findings on ultrasonography (USG) and DMSA scan, voiding cystourethrography (VCUG) has been considered to be unnecessary unless thereis an abnormal voiding pattern [1, 6, 7]. On the other hand, primary VUR is unusual in healthy children, butit occurs in approximately one-fourth to one- third of infants and children with UTI. Patients with VUR appear more prone to scarring and reflux nephropathy [ 2, 8]. In addition, long-term follow-up studies of patients with primary VUR and reflux nephropathy have demonstrated significant deterioration in renal function [ 9, 10], while dat from end-stage renaldisease(ESRD) registrieshave Pediatr Nephrol (2008) 23:2227–2232 DOI 10.1007/s00467-008-0907-x A. Soylu : B. K. Demir : M. Türkmen : Ö. Bekem : M. Saygı Department of Pediatrics, Dokuz Eylül University Medical Faculty, Izmir,Turkey H. Çakmakçı : S. Kavukçu Department of Radiology, Dokuz Eylül University Medical Faculty, Izmir,Turkey A. Soylu (*) Çamlıçay Mah, 5182 Sok. No:12/A, 35700 Urla, Izmir,Turkey e-mail: alper.soylu@deu.edu.tr