Dimercapto-Succinic Acid Scintigraphy Instead of Voiding Cystourethrography for Infants With Urinary Tract Infection

Hansson, Sverker; Dhamey, Manjit; Sigström, Olof; Sixt, Rune; Stokland, Eira; Wennerström, Martin; Jodal, Ulf

doi:10.1097/01.ju.0000135337.71154.60

Cited by 210 publications

(130 citation statements)

References 19 publications

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“…But to avoid a missed diagnosis, parents should be aware of the possibility of a recurring UTI and be advised to seek prompt treatment of any suspected reinfection. 14 This viewpoint is consistent with that of other recent studies, 4,6,17,20,29 all of which used the same top-down approach as well. It is worth emphasizing that the high sensitivity of the DMSA scan for the detection of dilating VUR in this study was because the scan was performed acutely within 1 week of the diagnosis.…”

Section: Discussionsupporting

confidence: 81%

“…15,16 The rate of VUR in patients with abnormal DMSA was 41.3% (164/ 397), which was also in agreement with previous data. 17 However, we noticed a relatively high percentage of dilating VUR (28.9% of patients; 187/1046 = 17.8% of renal units), which was higher than that reported in some studies, 5,18 but was close to the proportion found in other reports. 4,19,20 The large number of cases of dilating VUR in our country may be due to several reasons.…”

Section: Discussioncontrasting

confidence: 53%

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Accuracy of Early DMSA Scan for VUR in Young Children With Febrile UTI

Zhang

Zhou

et al. 2014

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT:The sensitivities of 99m Tcdimercaptosuccinic acid in predicting vesicoureteral reflux reported by different institutions were at different levels for young children with acute febrile urinary tract infection. Tc-dimercaptosuccinic acid (DMSA) scan in predicting dilating vesicoureteral reflux (VUR) among young children with a febrile urinary tract infection (UTI). WHAT THIS STUDY ADDS: METHODS:The medical records of children (#2 years of age), presenting with febrile UTI between January 2000 and December 2011, were retrospectively reviewed. RESULTS:A total of 523 children were included in this study, of whom 397 children (75.9%) had abnormal DMSA results and 178 children (34.0%) were identified as VUR on micturating cystourethrography (MCU). Among all the patients, the number of children with dilating VUR was 151 (28.9%). The rate of abnormal results on DMSA for the dilating VUR group was significantly higher than the rates for the non-VUR and low-grade VUR groups (P , .01). In the ,6 months age group and $6 months age group, the sensitivities of DMSA in predicting dilating VUR were 96.15% and 100.0%, respectively, the negative predictive values were 97.26% and 100.0%, respectively, and the negative likelihood ratios were 0.0911 and 0.0000, respectively. CONCLUSION: For children #2 years of age with a febrile UTI, an acute DMSA scan is valuable in the exclusion of dilating VUR. The likelihood of the presence of dilating VUR on MCU is rather low when the result of DMSA is negative. DMSA should be conducted to assess the need for an MCU. Pediatrics 2014;133:e30-e38 AUTHORS:

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Section: Discussionsupporting

confidence: 81%

Section: Discussioncontrasting

confidence: 53%

Accuracy of Early DMSA Scan for VUR in Young Children With Febrile UTI

Zhang

Zhou

et al. 2014

Pediatrics

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“…[22][23][24][25] Renal scintigraphy can detect the majority of the patients with moderate to severe reflux (grade 3 or higher). [21,26] Our findings also indicated the presence of a relationship between high-grade VUR and renal scarring. In our study, renal scarring was found relatively more frequently in patients aged 25-60 months with high VUR frequency.…”

Section: Discussionsupporting

confidence: 59%

Voiding cystourethrogram: How much should we be selective?

Yel

Tülpar

Düşünsel

et al. 2017

Turkish Journal of Urology

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Objective: In this study, we examined the patients' characteristics, who underwent voiding cystourethrography (VCUG), in order to determine any selectivity for indication of this invasive method. Material and methods:After exclusion of indications of neurogenic bladder or antenatal hydronephrosis and control VCUGs, 159 VCUGs performed in our clinic within one year were evaluated. Patients are divided into three groups accoding to age. Clinical characteristic and findings of renal ultrasonography (US) and renal scintigraphy were examined.Results: Vesicoureteral reflux (VUR) was detected in 61 (38.3%) of 159 patients who underwent cystourethrographic examinations, in 45.8% of the patients with a history of recurrent urinary tract infection (UTI), in 22.0% of the patients with pathological urinary system US without history of recurrent UTI. High-grade reflux rate was significantly more frequent in renal units with pathological US findings. Severe scar was significantly more frequent in renal units with high-grade reflux when compared to renal units without reflux and those with low-grade reflux. Predictive values of recurrent UTI, scarring status and pathological US for VUR were separately analyzed and seen that likelihood of indicating VUR was increased when all 3 risk factors were assessed together. Conclusion:Vesicoureteral reflux is a problem in which diagnostic process and management strategy should have to be considered in individualized manner for each patient. Before prescribing invasive VCUG, imaging urinary system by US and scintigraphy and determining whether there is recurrent UTI will improve selectivity and success of VCUG.

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“…41,44,51,56,57,62,63 The distributions of different reflux grades among children who had VUR are shown in Fig 4. There is significant variability in the relative predominance of each reflux grade, but grades II and III consistently are the most common. With the exception of the study by Camacho et al, 41 all studies showed grades IV and V to be the least frequent, and grade V accounted for 0% to 5% (weighted average: 3%) of reflux.…”

Section: Prevalence Of Vurmentioning

confidence: 99%

Diagnosis and Management of an Initial UTI in Febrile Infants and Young Children

Finnell¹,

Carroll²,

Downs³

2011

Pediatrics

176

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OBJECTIVES: The diagnosis and management of urinary tract infections (UTIs) in young children are clinically challenging. This report was developed to inform the revised, evidence-based, clinical guideline regarding the diagnosis and management of initial UTIs in febrile infants and young children, 2 to 24 months of age, from the American Academy of Pediatrics Subcommittee on Urinary Tract Infection. METHODS: The conceptual model presented in the 1999 technical report was updated after a comprehensive review of published literature. Studies with potentially new information or with evidence that reinforced the 1999 technical report were retained. Meta-analyses on the effectiveness of antimicrobial prophylaxis to prevent recurrent UTI were performed. RESULTS: Review of recent literature revealed new evidence in the following areas. Certain clinical findings and new urinalysis methods can help clinicians identify febrile children at very low risk of UTI. Oral antimicrobial therapy is as effective as parenteral therapy in treating UTI. Data from published, randomized controlled trials do not support antimicrobial prophylaxis to prevent febrile UTI when vesicoureteral reflux is found through voiding cystourethrography. Ultrasonography of the urinary tract after the first UTI has poor sensitivity. Early antimicrobial treatment may decrease the risk of renal damage from UTI. CONCLUSIONS: Recent literature agrees with most of the evidence presented in the 1999 technical report, but meta-analyses of data from recent, randomized controlled trials do not support antimicrobial prophylaxis to prevent febrile UTI. This finding argues against voiding cystourethrography after the first UTI.

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Dimercapto-Succinic Acid Scintigraphy Instead of Voiding Cystourethrography for Infants With Urinary Tract Infection

Abstract: DMSA scintigraphy in infants with UTI may replace VCU as a first line investigation. A strategy to perform VCU in only patients with renal lesions is proposed. In this study 147 of 303 VCUs would have been unnecessary as only 1 child with a damaged kidney was missed.

Cited by 210 publications

References 19 publications

Accuracy of Early DMSA Scan for VUR in Young Children With Febrile UTI

Accuracy of Early DMSA Scan for VUR in Young Children With Febrile UTI

Voiding cystourethrogram: How much should we be selective?

Diagnosis and Management of an Initial UTI in Febrile Infants and Young Children

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