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Response to commentary re model for predicting high -grade vesicoureteral reflux in young children presenting with febrile urinary tract infection

  • Nuntawan Piyaphanee
    Correspondence
    Correspondence to: Division of Nephrology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand.
    Affiliations
    Division of Nephrology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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  • Achra Sumboonnanonda
    Affiliations
    Division of Nephrology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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      Thank you so much for your comment. We do agree that voiding cystourethrography (VCUG) examination in young children with first febrile urinary tract infection (UTI) is still a controversial topic. Recently, a reduction in the use of the VCUG has occurred [
      • Garcia-Roig M.
      • Travers C.
      • McCracken C.E.
      • Kirsch A.J.
      National trends in the management of primary vesicoureteral reflux in children.
      ,
      • Lee T.
      • Ellimoottil C.
      • Marchetti K.A.
      • Banerjee T.
      • Ivančić V.
      • Kraft K.H.
      • et al.
      Impact of clinical guidelines on voiding cystourethrogram use and vesicoureteral reflux incidence.
      ]. Concern regarding missing those with reflux and renal scarring is important and needs more long-term data analysis.
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      References

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        National trends in the management of primary vesicoureteral reflux in children.
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      Linked Article

      • Commentary to model for predicting high -grade vesicoureteral reflux in young children presenting with febrile urinary tract infection
        Journal of Pediatric UrologyVol. 18Issue 4
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          The authors employ three well known imaging and clinical risk factors associated with vesicoureteral reflux (recurrent UTI, non-E. coli pathogen, abnormal renal and bladder ultrasound) to create a scoring system for limiting the use of a VCUG in all children who present with a febrile UTI. It is no surprise that the presence of any one of these factors alone identifies an appreciable number of children with high grade (III–V) reflux. The authors, along with the American Academy of Pediatrics and the British National Institute for Clinical Excellence, have striven to reduce the use of the VCUG and are content with missing some with reflux and renal scarring.
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