ABSTRACT
PURPOSE: This study was conducted to determine the predictive value of clinical, laboratory, and imaging variables for the diagnosis of vesicoureteral reflux in children with their first febrile urinary tract infection. MATERIALS AND METHODS: One hundred fifty-three children with their first febrile urinary tract infection were divided into two groups according to the results of voiding cystourethrography: 60 children with vesicoureteral reflux and 93 children without. The sensitivity, specificity, positive and negative predictive value, likelihood ratio (positive and negative), and accuracy of the clinical, laboratory, and imaging variables for the diagnosis of vesicoureteral reflux were determined. RESULTS: Of the 153 children with febrile urinary tract infection, 60 patients (39.2%) had vesicoureteral reflux. There were significant differences between the two groups regarding fever>38degrees C, suprapubic pain, C-reactive protein quantitative level, number of red blood cells in the urine, and results of renal ultrasound and dimercaptosuccinic acid renal scanning (p38.2degrees C and dimercaptosuccinic acid renal scanning and vesicoureteral reflux. Also, there were significant positive correlations between the erythrocyte sedimentation rate, positive urinary nitrite test, hyaline cast, and renal ultrasound and high-grade vesicoureteral reflux. CONCLUSIONS: This study revealed fever>38.2degrees C and dimercaptosuccinic acid renal scanning as the best predictive markers for vesicoureteral reflux in children with their first febrile urinary tract infection. In addition, erythrocyte sedimentation rate, positive urinary nitrite test, hyaline cast, and renal ultrasound are the best predictive markers for high-grade vesicoureteral reflux.
Subject(s)
Child , Child, Preschool , Female , Humans , Infant , Male , Biomarkers/metabolism , Blood Sedimentation , C-Reactive Protein/metabolism , Cross-Sectional Studies , Fever/etiology , Kidney/diagnostic imaging , Predictive Value of Tests , Radiopharmaceuticals , Sensitivity and Specificity , Technetium Tc 99m Dimercaptosuccinic Acid , Urinary Tract Infections/etiology , Vesico-Ureteral Reflux/complicationsABSTRACT
PURPOSE: The diagnosis of acute pyelonephritis (APN) is often difficult, as its clinical and biological manifestations are non-specific in children. If not treated quickly and adequately, however, APN may cause irreversible renal damage, possibly leading to hypertension and chronic renal failure. We were suspecting the diagnostic value of 99mTc-dimercaptosuccinic acid (DMSA) scan by experiences and so compared the results of DMSA scan to those of multi-detector row computed tomography (MDCT). METHODS: We retrospectively selected and analyzed 81 patients who were diagnosed as APN by MDCT during evaluation of their acute abdomen in emergency room and then received DMSA scan also for the diagnostic work-up of APN after admission. We evaluated the results of imaging studies and compared the diagnostic value of each method by age groups, or =2 years (n=36). RESULTS: Among total 81 patients with MDCT-proven APN. DMSA scan was diagnostic only in 55 children (68%), while the remaining 26 children (32%) showed false negative normal findings. These 26 patients were predominantly male with average age of 21 months and most of them, 19 (73.1%) were <2 years of age. CONCLUSION: DMSA scan has obvious limitation compared to MDCT in depicting acute inflammatory lesions of kidney in children with APN, especially in early childhood less than 2 years of age. MDCT showed hidden lesions of APN, those were undetectable through DMSA scan in children.
Subject(s)
Child , Humans , Male , Abdomen, Acute , Emergencies , Hypertension , Kidney , Kidney Failure, Chronic , Pyelonephritis , Retrospective Studies , Succimer , Technetium Tc 99m Dimercaptosuccinic AcidABSTRACT
PURPOSE: Acute pyelonephritis in children may lead to permanent renal scarring with a risk of later hypertension and renal failure and so needs prompt diagnosis and appropriate treatment. The main aim of this study was to evaluate the value of 99mTc-dimercaptosuccinic acid(DMSA) renal scan in detecting renal involvement of acute urinary tract infection(UTI) and determining the sensitivity to find coexisting vesicoureteral reflux(VUR) in children. MATERIALS AND METHODS: A total of 192 children(97 males, 95 females) admitted with bacteriologically proven and symptomatic UTI between May 1994 and April 1997 were analysed. DMSA renal scan was performed in all cases. 70 children underwent VCUG. Findings of DMSA renal scan were analysed according to age, sex, previous history of UTI and VUR. RESULTS: 89 children(46%) were under the age of 1 year. There was a preponderance of UTI in boys under the age of 1 year(66.3%) and in girls over the age of 1 year(63.1%). Of the 192 children studied, 155 children(80.7%, 81 males, 74 females) had first episode and the remaining 37 children(19%, 16 males, 21 females) had previous history of symptomatic UTI. Abnormalities in DMSA renal scan were found in 67(43.2%) of 155 children with the first UTI and in 30(89%) of 37 children with recurrent UTI. Bilateral DMSA abnormalities were noted in 8(5.2%) of 155 children with the first UTI and in 11(29.7%) of 37 children with recurrent UTI. Of the 70 children who underwent VCUG, VUR was seen in 41(58.6%) children. Of the 41 children with VUR, 31(90.2%) children had abnormal DMSA images. VUR was demonstrated in 37(75.5%) of 49 children with abnormal DMSA images and especially in 100% of 14 children with bilateral abnormal DMSA images. CONCLUSIONS: A high proportion of abnormal DMSA images was found in children with recurrent UTI and children with VUR, especially high grade or bilateral reflux. DMSA renal scan is a sensitive method for evaluating the functional defect of involved kidney and predicting coexistent VUR according to its image appearance in patients with UTI.
Subject(s)
Child , Female , Humans , Male , Cicatrix , Diagnosis , Hypertension , Kidney , Pyelonephritis , Renal Insufficiency , Succimer , Urinary Tract Infections , Urinary Tract , Vesico-Ureteral RefluxABSTRACT
PURPOSE: Acute pyelonephritis in children may lead to permanent renal scarring with a risk of later hypertension and renal failure and so needs prompt diagnosis and appropriate treatment. The main aim of this study was to evaluate the value of 99mTc-dimercaptosuccinic acid(DMSA) renal scan in detecting renal involvement of acute urinary tract infection(UTI) and determining the sensitivity to find coexisting vesicoureteral reflux(VUR) in children. MATERIALS AND METHODS: A total of 192 children(97 males, 95 females) admitted with bacteriologically proven and symptomatic UTI between May 1994 and April 1997 were analysed. DMSA renal scan was performed in all cases. 70 children underwent VCUG. Findings of DMSA renal scan were analysed according to age, sex, previous history of UTI and VUR. RESULTS: 89 children(46%) were under the age of 1 year. There was a preponderance of UTI in boys under the age of 1 year(66.3%) and in girls over the age of 1 year(63.1%). Of the 192 children studied, 155 children(80.7%, 81 males, 74 females) had first episode and the remaining 37 children(19%, 16 males, 21 females) had previous history of symptomatic UTI. Abnormalities in DMSA renal scan were found in 67(43.2%) of 155 children with the first UTI and in 30(89%) of 37 children with recurrent UTI. Bilateral DMSA abnormalities were noted in 8(5.2%) of 155 children with the first UTI and in 11(29.7%) of 37 children with recurrent UTI. Of the 70 children who underwent VCUG, VUR was seen in 41(58.6%) children. Of the 41 children with VUR, 31(90.2%) children had abnormal DMSA images. VUR was demonstrated in 37(75.5%) of 49 children with abnormal DMSA images and especially in 100% of 14 children with bilateral abnormal DMSA images. CONCLUSIONS: A high proportion of abnormal DMSA images was found in children with recurrent UTI and children with VUR, especially high grade or bilateral reflux. DMSA renal scan is a sensitive method for evaluating the functional defect of involved kidney and predicting coexistent VUR according to its image appearance in patients with UTI.
Subject(s)
Child , Female , Humans , Male , Cicatrix , Diagnosis , Hypertension , Kidney , Pyelonephritis , Renal Insufficiency , Succimer , Urinary Tract Infections , Urinary Tract , Vesico-Ureteral RefluxABSTRACT
The early radiological investigations of urinary tract infection are justified nowadays in order to identify those whose kidneys are already damaged, those who may be at risk of progressive damage, and those in whom a treatment program is indicated. 42 children who performed 99mTc-dimercaptosuccinic acid scan in the diagnostic step of recurrent urinary tract infection for recent 3 years at Severance Hospital were evaluated to access the validity of 99 m Tc-dimercaptosuccinic acid scan in detection of pyelonephritic scarring. The results were as follows: 1. Renal cortical defects were detected in 34 kidneys among 84 kidneys(40.5%) by DMSA scan, intravenous pyelography and ultrasonography 2. DMSA scan was significantly more valuable in detecing renal defect than intravenous pyelography (P<0.05). 3. The presence of reflux on voiding cystourethrography showed a significant correlation with renal cortical defects seen on DMSA scan (P<0.05). 4. The sensitivity of the DMSA scan in screening for all grades of reflux was estimated 0.9 and DMSA scan never missed renal defects in high grade (III-V/V) reflux. So we conclude that 99 m Tc-DMSA scan is more useful than other upper urinary tract imaging technique in detecting renal defects and consideration should be given to their use as first line of study for screening of renal defect in urinary tract infection and vesicoureteral reflux.