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Background <p>Current international guidelines recommend voiding cystourethrography (VCUG) for infants with atypical or recurrent urinary tract infection (UTI), but the predictive value of normal renal ultrasound in excluding high-grade vesicoureteral reflux (VUR) and adverse outcomes in infants under 6 months remains unclear. This study aimed to determine whether normal ultrasound findings after the first febrile UTI can safely predict benign clinical outcomes in this vulnerable age group.</p> Methods <p>We conducted a retrospective chart review of 71 infants aged 0–6 months admitted to King Fahad Medical City, Riyadh, Saudi Arabia, between January 2023 and January 2025 with their first febrile UTI. Patients were stratified by renal ultrasound findings (normal vs. abnormal) and followed for 12 months. Primary outcomes included high-grade VUR (grades IV-V), acute kidney injury (AKI), chronic kidney disease (CKD), recurrent UTI, and renal scarring on dimercaptosuccinic acid (DMSA) scan.</p> Results <p>Among 71 patients (71.8% male, median age 1.9 months), 67.6% had abnormal ultrasound findings. Normal ultrasound demonstrated 100% negative predictive value for high-grade VUR (grades IV-V)(0/23 patients with normal ultrasound had grades IV-V VUR versus 13/48 [27.1%] with abnormal ultrasound; <i>p</i> &lt; 0.001). All cases of AKI occurred exclusively in patients with abnormal ultrasound (10/48 vs. 0/23; RR = 1.60, <i>p</i> &lt; 0.001). Similarly, CKD at 12 months was observed only in the abnormal ultrasound group (6/48 vs. 0/23; <i>p</i> &lt; 0.001). Multivariate analysis revealed that abnormal ultrasound independently predicted ICU admission (aOR = 9.00, <i>p</i> = 0.04), vesicoureteral reflux (aOR = 3.43, <i>p</i> &lt; 0.01), and renal scarring on DMSA (aOR = 4.00, <i>p</i> = 0.01).</p> Conclusions <p>Normal renal ultrasound after the first febrile UTI in infants under 6 months effectively excludes high-grade VUR and predicts benign clinical outcomes with 100% negative predictive value (95% CI: 85.2%–100%). These findings support selective imaging strategies that reserve VCUG for infants with abnormal ultrasound, atypical UTI, or recurrent infections, potentially reducing unnecessary invasive procedures while maintaining complete detection of clinically significant pathology.</p>

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Predictive value of normal renal ultrasound after first febrile UTI in infants under six months: a retrospective chart review

  • 期刊论文

  • 发表日期：

    2026年3月10日

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  • Faten Ahmad Alkateb,
  • Awatif K. Almutairi,
  • Zaki Obaid,
  • Duaa Dyab,
  • Ghaith Adi

摘要

Background

Current international guidelines recommend voiding cystourethrography (VCUG) for infants with atypical or recurrent urinary tract infection (UTI), but the predictive value of normal renal ultrasound in excluding high-grade vesicoureteral reflux (VUR) and adverse outcomes in infants under 6 months remains unclear. This study aimed to determine whether normal ultrasound findings after the first febrile UTI can safely predict benign clinical outcomes in this vulnerable age group.

Methods

We conducted a retrospective chart review of 71 infants aged 0–6 months admitted to King Fahad Medical City, Riyadh, Saudi Arabia, between January 2023 and January 2025 with their first febrile UTI. Patients were stratified by renal ultrasound findings (normal vs. abnormal) and followed for 12 months. Primary outcomes included high-grade VUR (grades IV-V), acute kidney injury (AKI), chronic kidney disease (CKD), recurrent UTI, and renal scarring on dimercaptosuccinic acid (DMSA) scan.

Results

Among 71 patients (71.8% male, median age 1.9 months), 67.6% had abnormal ultrasound findings. Normal ultrasound demonstrated 100% negative predictive value for high-grade VUR (grades IV-V)(0/23 patients with normal ultrasound had grades IV-V VUR versus 13/48 [27.1%] with abnormal ultrasound; p < 0.001). All cases of AKI occurred exclusively in patients with abnormal ultrasound (10/48 vs. 0/23; RR = 1.60, p < 0.001). Similarly, CKD at 12 months was observed only in the abnormal ultrasound group (6/48 vs. 0/23; p < 0.001). Multivariate analysis revealed that abnormal ultrasound independently predicted ICU admission (aOR = 9.00, p = 0.04), vesicoureteral reflux (aOR = 3.43, p < 0.01), and renal scarring on DMSA (aOR = 4.00, p = 0.01).

Conclusions

Normal renal ultrasound after the first febrile UTI in infants under 6 months effectively excludes high-grade VUR and predicts benign clinical outcomes with 100% negative predictive value (95% CI: 85.2%–100%). These findings support selective imaging strategies that reserve VCUG for infants with abnormal ultrasound, atypical UTI, or recurrent infections, potentially reducing unnecessary invasive procedures while maintaining complete detection of clinically significant pathology.