Does urinary tract ultrasonography at hospitalization for acute pyelonephritis predict vesicoureteral reflux?

Purpose: We evaluate the correlation between urinary tract ultrasound during hospitalization for acute pyelonephritis with subsequent voiding cystourethrography in children. Materials and Methods: Medical records were reviewed of 184 children up to 18 years old who were evaluated with ultrasound during hospitalization for acute pyelonephritis between January 1988 and January 1996. Followup voiding cystourethrography results were compared to the initial ultrasound findings. Results: Ultrasound was performed at mean hospital day 2.1 and voiding cystourethrography was done 39 days later. Of the ultrasound studies 77 (42%) were abnormal, and two-thirds of these abnormalities were upper tract dilatation. Subsequent voiding cystourethrography was performed in 76% of the study population, including 67% of those with normal and 87% of those with abnormal ultrasound. Voiding cystourethrography revealed reflux in 39% of children with upper tract dilatation compared to 35% of those with normal and 36% with abnormal ultrasound for any reason. In addition, the severity of reflux on voiding cystourethrography could not be predicted by ultrasound findings. Conclusions: Ultrasound findings during acute pyelonephritis do not correlate with and are not predictive of the presence or grade of vesicoureteral reflux on subsequent voiding cystourethrography.