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Correspondence |
I would like to comment on the recent article in this journal by Howard et al [1]. They claim that their article was the first in the international literature regarding the prevalence of vesicoureteric reflux (VUR) and renal scarring in Chinese children with urinary tract infection (UTI). However, there were already three reports on the same subject published in local journals that were not quoted [2–4]. The problem is that they are not indexed in Index Medicus. Supplementing the results of these studies should provide a more complete and accurate picture of the prevalence of UTI in Chinese children. Voiding cystourethrography was performed in 125, 81 and 43 children, respectively, in the three studies [2–4] and VUR was detected in 27, 21 and 10 patients, yielding a prevalence of VUR of 21.6%, 26% and 23.2%, respectively. If the results of these three studies are combined with those of Howard et al [1], the prevalence of VUR will be 94/342 cases (27.5%). The prevalence detected in these earlier studies is lower than the 39% reported by Howard et al [1]. This may be due to the definitions of UTI employed in the different studies. In the earlier studies [2–4], culture result from bag urine/midstream urine was accepted as one of the diagnostic criteria for UTI. Thus, overdiagnosis of UTI could result, yielding a lower prevalence of VUR in UTI. In the study of Howard et al [1], however, the diagnostic criteria were not mentioned.
The prevalence of renal scarring was less clear, as 99Tc dimercaptosuccinic acid (DMSA) scans were not popular at the time these studies were carried out.
Another peculiar feature of UTI in Chinese children is the male predominance, but this was not discussed in the article of Howard et al [1]. The male:female ratio was 2.32 in the report of Howard et al and the ratios were 1.56, 3.6 and 2.12 in the other three reports. The consistency of these findings suggests that male predominance is probably genuine. This feature is contrary to the female predominance of UTI found in studies in the White population [5]. The reason for the male predominance of UTI in Chinese children remains obscure.
Yours etc.,
Department of Paediatrics and Adolescent Medicine Princess Margaret Hospital, Princess Margaret Hospital Road, Kowloon, SAR, Hong Kong
Received for publication July 31, 2001. Accepted for publication August 3, 2001.
References
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