Renal cortical scan as the first investigation in identifying children at risk for vesicoureteral reflux and renal defects: A 10-year retrospective review of DMSA and VCUG imaging in patients with first febrile urinary tract infection

ABSTRACT

The objective of the study is to determine the accuracy of renal cortical scan in detection of vesicoureteral reflux (VUR) in children five years old and below diagnosed with urinary tract infection and to determine if Renal cortical scan can predict the prevalence of VUR in children and screening those who will need voiding cystourethrography (VCUG).METHODS: The medical records of 302 patients who presented with a first febrile urinary tract infection and underwent VCUG and renal cortical scan during a 10-year period starting from 2000 to 2010 were reviewed retrospectively. Patients with systemic diseases other than acute pyelonephritis/VUR and those with other concomitant anatomic or neurological abnormalities were dropped from the study. Included participants were then grouped according to age range; 1 day to 1 month, 1 to 12 months, 13 to 24 months, and 2 to 5 years.RESULTS: The study consisted of 302 patients and 604 renal units. Males were 45.3% and females were 54.6% of the population. Computed odds ratio and relative risk associated with positive VUR and renal cortical scan using dimercaptosuccinic acid (DMSA) was at 4.15 [Cl 2.93-5.908] and 2.398 [Cl 1.924-2.989] respectively. This suggests that patients with positive Renal cortical scans are 4.15 times more likely to have VUR, or conversely, the risk of developing VUR with a positive renal cortical scan is approximately 2.398 times than if DMSA results were negative. Renal cortical scan has been found to be 96.6% sensitive in detecting VUR among patients with the condition and is 89.82% specific in detecting the absence of VUR among normal individuals [PPV 55.8% and NPV 76.7%].CONCLUSION: Renal cortical scan could be used a first line imaging investigation tool for determining high grade VUR. VCUG may not be necessary in all young children with first febrile UTI when the renal cortical scan is negative. VCUG could be warranted only foe those children with positive results on renal cortical scan.