Vesicoureteral Reflux in Children with Accidental Diagnosis of Unilateral Small Size Kidney.

Objective: A majority of small size kidney in children were diagnosed after a urinary tract infection (UTI) and with high-grade vesicoureteral reflux (VUR). This study was conducted in children who were diagnosed accidentally and investigated for VUR and UTI.

Methods: This longitudinal retrospective study was conducted in children with a diagnosis of a small kidney accidentally discovered by ultrasonography and referred to Children's Hospital in Babol, Iran, between 2012-2022. They were investigated by DMSA (dimercapto succinic acid) renoscintigraphy scans. Vesicoureteral reflux was diagnosed by voiding C\cystourethrography (VCUG) or radionuclide cystography (RNC). All children were followed for at least for 1 year with urine culture and urinalysis every 1-2 months for detection of UTI. Significance was set at P less than .05.

Results: The mean age of the children with small-size kidneys was 5.52 ± 3.70 years, and 58.1% were boys. Out of the 86 children, 28 (32.6%) were found to have VUR, with approximately 71.4% of them being boys. Breaking down by gender, 40% of boys and 28.6% of girls with small-sized kidneys had VUR. Among the children with and without VUR, 42.9% and 10.3% experienced UTIs, respectively (P=.74). The predominant causative microorganism for UTIs was Escherichia coli (55.6%), with Klebsiella (22.4%) and Enterobacter (22.4%) accounting for the remaining cases.

Conclusion: Accidental diagnoses of small-size kidneys in children revealed a notable presence of VUR, with a higher prevalence in boys. This suggests that VUR may constitute a significant etiological factor in the development of small-size kidneys. We recommend that these children must be evaluated for VUR.