Early <sup>99m</sup>Tc dimercaptosuccinic acid (DMSA) scintigraphy in symptomatic first‐time urinary tract infection

Stokland, Eira; Hellström, Mikael; Jacobsson, Bo; Jodal, Ulf; Lundgren, Pia; Sixt, Rune

doi:10.1111/j.1651-2227.1996.tb14055.x

Cited by 115 publications

(86 citation statements)

References 29 publications

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“…In contrast to previous studies, 38 our data revealed that CRP is not a very sensitive marker for localizing UTI site. However, Melis et al 39 found elevated CRP and ESR in 57% and 83%, respectively, which is in accordance with our results.…”

Section: Discussioncontrasting

confidence: 54%

Polymorphonuclear Elastase as a Diagnostic Marker of Acute Pyelonephritis in Children

Fretzayas¹,

Moustaki²,

Gourgiotis³

et al. 2000

Pediatrics

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ABSTRACT. Objective. Experimental evidence suggests that neutrophils and their metabolites play an important role in the pathogenesis of pyelonephritis. The aim of this study was to investigate the diagnostic value of polymorphonuclear elastase-a 1 -antitrypsin complex (E-a 1 -Pi) for the detection of acute pyelonephritis in children.Methods. Eighty-three patients, 29 boys and 54 girls, 25 days to 14 years of age, with first-time symptomatic urinary tract infection were prospectively studied. Fiftyseven healthy children served as controls. Dimercaptosuccinic acid (DMSA) scan and voiding cystourethrography were performed in all patients. Plasma and urinary E-a 1 -Pi, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), neutrophil count, urinary N-acetyl-␤-glucosaminidase (NAG), N-acetyl-␤-glucosaminidase b (NAG b), and creatinine levels were measured in all patients on admission and 3 days after the introduction of antibiotics. The same markers were also measured in the control subjects.Results. Planar DMSA scintigraphy demonstrated changes of acute pyelonephritis in 30 of 83 children (group A). It was normal in the remaining 53 children (group B). The sex and age distributions were not significantly different between the 2 groups, as well as between the patients and the control subjects (group C). Nineteen of the 53 children with a normal DMSA had body temperature >38°C, whereas all but 4 children with abnormal DMSA had temperature >38°C. Therefore, the temperature was significantly different between these 2 groups. The sensitivity and specificity of fever (>38°C) as an indicator of renal involvement based on isotopic findings were 86% and 64%, respectively. Given the significant number of the febrile children with normal DMSA scintiscans, group B was subdivided into B 1 with 19 febrile children (14 boys and 5 girls) and B 2 with 34 children whose body temperature was below 38°C (8 boys and 26 girls). The sex and age distribution was significantly different between groups B 1 and B 2 . The mean age of group B 1 was .78 years (range: 28 days to 9 years; median: .25 years; standard deviation: 2.1). All but 1 child in this group were younger than 1 year of age. In contrast, in group B 2 , there were only 4 infants, the remaining 30 children were older than 2.5 years (mean age: 6 years; median: 7 years; standard deviation: 3.5; range: 34 days to 12 years). The mean duration of fever before hospital admission was 2.8 days for group A and 1.8 days for group B 1 . This difference was not statistically significant. Similarly, body temperature was not significantly different between these 2 groups. The distribution of plasma E-a 1 -Pi values was normal in the control subjects. The sensitivity and specificity of plasma E-a 1 -Pi, as an indicator of renal involvement, were 96% and 50%, respectively, taking the 95th percentile of the reference range as a cutoff value. However, considering as a cutoff value the level of 72 g/dL (95th percentile of group B 2 ), its sensitivity and specificity were 74% and 86%, resp...

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Section: Discussioncontrasting

confidence: 54%

Polymorphonuclear Elastase as a Diagnostic Marker of Acute Pyelonephritis in Children

Fretzayas¹,

Moustaki²,

Gourgiotis³

et al. 2000

Pediatrics

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“…Among them, 16% of patients were diagnosed with VUR grade I and II, while 19.5% of the cases were diagnosed with VUR III-V. This is slightly higher than that reported in Turkey (19.4) and lower than that found in Kuwait (33%) (6,18,22,23). All patients with grade I and II were referred to the pediatric department for follow-up and they were excluded from this study, whereas higher grades were corrected endoscopically.…”

Section: Discussioncontrasting

confidence: 45%

The Relationship Between Vesicoureteral Reflux and Recurrent Urinary Tract Infection in Children in Kurdistan Region, Iraq

2018

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Background: Recurrent urinary tract Infection (UTI) is a common problem in pediatric age group. Vesicoureteral reflux (VUR) is a common cause for recurrent UTI. Objectives: This study was conducted to determine the prevalence of VUR in children who presented with recurrent UTIs and to assess the effect of endoscopic treatment in patients with grade III-V VUR. Methods: This was a prospective study recruiting 1232 patients who presented with recurrent UTI during April 2008 and January 2012. We used voiding cystourethrogram to diagnose VUR, and treated grades III-V VUR by bulking agent. One to 2 sessions were performed and the participants were followed-up postoperatively at first, second, third, and 12th months postoperatively. Results: VUR was found in 437 (35.5%) of the patients. Amongst those, 197 (16%) patients were diagnosed with VUR grade I and II. Additionally, 240 (19.5%) cases were diagnosed with VUR III-V. Two sessions were required to correct the reflux in all patients with grade III. The success rate of correction of grade IV was 79% after the second session. The success rate was 71% in grade V. New contralateral reflux with low grade (I and II) de novo VUR was found in 28/240 (11.7%) cases. After successful correction of VUR, UTI occurred in 12/203 (5.9%) of the patients. Conclusions: VUR was common in children with recurrent UTI with a good prognosis after endoscopic correction. Further study is needed to follow-up the participants who did not respond to treatment.

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“…Originally there appeared to be a difference in outcomes with infection occurring under the ages of 3 to 5 based on studies which found a higher incidence of renal scarring in this age group (8,21,50,77). However numerous studies have found that scarring can and does occur later (7,22,38,57,64,68). In fact some studies have shown that neonates and infants may actually have a decreased incidence of scarring and abnormalities compared to older children (6,10,14).…”

Section: Age Differencesmentioning

confidence: 99%

Diagnosis and Management of Pediatric Urinary Tract Infections

2005

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Urinary tract infection (UTI) is among the most commonly diagnosed bacterial infections of childhood. Although frequently encountered and well researched, diagnosis and management of UTI continue to be a controversial issue with many challenges for the clinician. Prevalence studies have shown that UTI may often be missed on history and physical examination, and the decision to screen for UTI must balance the risk for missed infections with the cost and inconvenience of testing. Interpretation of rapid diagnostic tests and culture is complicated by issues of contamination, false test results, and asymptomatic colonization of the urinary tract with nonpathogenic bacteria. The appropriate treatment of UTI has been controversial and has become more complex with the emergence of resistance to commonly used antibiotics. Finally, the anatomic evaluation and long-term management of a child after a UTI have been based on limited evidence, and newer studies question some of the tenets of prior recommendations. The goal of this review is to provide an up-to-date summary of the literature with particular attention to practical questions about diagnosis and management for the clinician

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Early ^99mTc dimercaptosuccinic acid (DMSA) scintigraphy in symptomatic first‐time urinary tract infection

Cited by 115 publications

References 29 publications

Polymorphonuclear Elastase as a Diagnostic Marker of Acute Pyelonephritis in Children

Polymorphonuclear Elastase as a Diagnostic Marker of Acute Pyelonephritis in Children

The Relationship Between Vesicoureteral Reflux and Recurrent Urinary Tract Infection in Children in Kurdistan Region, Iraq

Diagnosis and Management of Pediatric Urinary Tract Infections

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Early 99mTc dimercaptosuccinic acid (DMSA) scintigraphy in symptomatic first‐time urinary tract infection

Cited by 115 publications

References 29 publications

Polymorphonuclear Elastase as a Diagnostic Marker of Acute Pyelonephritis in Children

Polymorphonuclear Elastase as a Diagnostic Marker of Acute Pyelonephritis in Children

The Relationship Between Vesicoureteral Reflux and Recurrent Urinary Tract Infection in Children in Kurdistan Region, Iraq

Diagnosis and Management of Pediatric Urinary Tract Infections

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Early ^99mTc dimercaptosuccinic acid (DMSA) scintigraphy in symptomatic first‐time urinary tract infection