Neutrophil-to-lymphocyte ratio as a predictor of primary vesicoureteral reflux evolution in children with associated acute pyelonephritis

“Primary vesicoureteral reflux (VUR) is a congenital disorder, typically resulting from a short submucosal tract at the junction between ureter and bladder, not associated with other obstructive, neurological or vascular abnormalities."

"It is one of the most common urological diseases in childhood, with an estimated prevalence of 0.4–1.8% in the general pediatric population and up to 30% in children with a history of urinary tract infection (UTI). In these patients, VUR plays an important role in the pathogenesis of UTIs as the relationship between acute pyelonephritis (APN), VUR and renal damage is well established."

"This potential morbidity makes early diagnosis essential, as well as the determination of the clinical course of VUR, due to the high percentage of spontaneous resolution (SR) observed during its evolution.”

“Imaging studies performed included urinary ultrasound, Tc-99m-dimercaptosuccinic acid (DMSA) renal scan scintigraphy, voiding cystourethrography (VCUG). After APN diagnosis, urinary ultrasound and DMSA were performed during the first 5 days of admission. Subsequently, VCUG was performed 4 weeks after APN resolution, in order to evaluate the presence of VUR as well as the degree and laterality. Follow-up was performed by reviews in the outpatient clinic every 3 months, with repeat VCUG to monitor the VUR clinical course at 6-monthly intervals.”

“NLR may be considered as a simple and cost-effective predictor of clinical outcome of VUR, which correlates with the increased risk of developing complications of primary VUR after an episode of APN during follow-up. Therefore, it should be included in the management algorithm for these patients, although future prospective studies are still required to confirm these results.”