Recurrent urinary tract infections in young children: role of DMSA scintigraphy in detecting vesicoureteric reflux

Awais, Muhammad; Zaman, Maseeh uz; Nadeem, Naila

doi:10.1007/s00247-014-3062-5

Cited by 9 publications

(5 citation statements)

References 28 publications

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“…Awais et al reported that Tc-99m DMSA scintigraphy has high sensitivity and negative predictive value on patients with high grade VUR (Grade 3 and higher) and also it has benefit of exclusion of high grade VUR (Awais et al, 2015). In our study, as the VUR grade increased, the probability of renal damage in the kidneys was increased.…”

Section: Discussionsupporting

confidence: 57%

The Efficacy of Tc-99m DMSA Scintigraphy in Children with Vesicoureteral Reflux Accompanying Frequent Urinary Tract Infection

Çelikkaya

Atıcı

Atilgan

2019

Middle Black Sea Journal of Health Science

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Objective: Urinary tract infection is one of the most common diseases in childhood. Experimental studies have shown that renal damage due to urinary tract infection can be prevented by early diagnosis and treatment. The aim of this study was to evaluate the correlation between vesicoureteral reflux grade and Technetium-99m-dimercaptosuccinic acid scintigraphy in patients with frequent urinary tract infection Methods Between January and October 2017, 34 cases were diagnosed as vescoureteral reflux with voiding cystoureterography were retrospectively evaluated with Technetium-99m-dimercaptosuccinic acid scintigraphy in terms of renal scar and function. Scars and function ratios were evaluated in Technetium-99m-dimercaptosuccinic acid scintigraphy according to voiding cystourethrography grades and correlation between the vesicoureteral reflux grade and Technetium-99m-dimercaptosuccinic acid scintigraphy findings were investigated. Results: Of 34 patients, 26 (76.5%) were female and 8 (23.5%) were male. The mean age of the patients was 6.08 ± 4.03 (min: 1 month, max: 17 years). Twenty-one patients had unilateral vesicoureteral reflux and 13 patients had bilateral vesicoureteral reflux. Vesicoureteral reflux were detected in 47 of the total 68 kidneys. Conclusion: In children with vesicoureteral reflux, Technetium-99m-dimercaptosuccinic acid scintigraphy provides useful information to show the kidney damage and as the vesicoureteral reflux grade increases, the rate of kidney damage increases. Even in the case of grade 1 and grade 2 vesicoureteral reflux, which are not expected to cause renal parenchymal damage. Technetium-99m-dimercaptosuccinic acid scintigraphy is the most successful imaging method for detecting parenchymal injury.

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Section: Discussionsupporting

confidence: 57%

The Efficacy of Tc-99m DMSA Scintigraphy in Children with Vesicoureteral Reflux Accompanying Frequent Urinary Tract Infection

Çelikkaya

Atıcı

Atilgan

2019

Middle Black Sea Journal of Health Science

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“…Decreased renal uptake of the isotope suggests acute pyelonephritis or renal scarring [31, 41]. In addition, a DMSA renal scan can detect majority (> 70%) of children with moderate to severe vesicoureteric reflux [41, 102]. The routine uses of this imaging modality is not generally recommended due to the radiation hazard and the cost involved [20].…”

Section: Diagnostic Imaging Studiesmentioning

confidence: 99%

“…The NICE guidelines recommend DMSA renal scan 4 to 6 months after atypical UTI in children under 3 years of age and recurrent UTI in children of any age [84]. It has been suggested that a normal DMSA renal scan may obviate the need for voiding cystourethrogram in children with recurrent UTI [102]. If a DMSA renal scan has to be performed, it should be performed in the acute phase to detect acute pyelonephritis or 4 to 6 months later to assess for renal scarring [2].…”

Section: Diagnostic Imaging Studiesmentioning

confidence: 99%

Urinary Tract Infection in Children

Leung

Wong

Leung

et al. 2019

IAD

167

105

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Background: Urinary Tract Infection (UTI) is a common infection in children. Prompt diagnosis and appropriate treatment are very important to reduce the morbidity associated with this condition. Objective: To provide an update on the evaluation, diagnosis, and treatment of urinary tract infection in children. Methods: A PubMed search was completed in clinical queries using the key terms “urinary tract infection”, "pyelonephritis" OR "cystitis". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. The search was restricted to English literature and the pediatric age group. Patents were searched using the key terms “urinary tract infection” "pyelonephritis" OR "cystitis" from www.google.com/patents, http://espacenet.com, and www.freepatentsonline.com. Results: Escherichia coli accounts for 80 to 90% of UTI in children. The symptoms and signs are nonspecific throughout infancy. Unexplained fever is the most common symptom of UTI during the first two years of life. After the second year of life, symptoms and signs of pyelonephritis include fever, chills, rigor, flank pain, and costovertebral angle tenderness. Lower tract symptoms and signs include suprapubic pain, dysuria, urinary frequency, urgency, cloudy urine, malodorous urine, and suprapubic tenderness. A urinalysis and urine culture should be performed when UTI is suspected. In the work-up of children with UTI, physicians must judiciously utilize imaging studies to minimize exposure of children to radiation. While waiting for the culture results, prompt antibiotic therapy is indicated for symptomatic UTI based on clinical findings and positive urinalysis to eradicate the infection and improve clinical outcome. The choice of antibiotics should take into consideration local data on antibiotic resistance patterns. Recent patents related to the management of UTI are discussed. Conclusion: Currently, a second or third generation cephalosporin and amoxicillin-clavulanate are drugs of choice in the treatment of acute uncomplicated UTI. Parenteral antibiotic therapy is recommended for infants ≤ 2 months and any child who is toxic-looking, hemodynamically unstable, immunocompromised, unable to tolerate oral medication, or not responding to oral medication. A combination of intravenous ampicillin and intravenous/intramuscular gentamycin or a third-generation cephalosporin can be used in those situations. Routine antimicrobial prophylaxis is rarely justified, but continuous antimicrobial prophylaxis should be considered for children with frequent febrile UTI.

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“…If the acute DMSA is negative, a MCUG is not performed. Some studies have shown a strong correlation between clinically relevant VUR with dilatation and abnormal scintigraphic scans (24,(109)(110)(111)(112)(113); however, other studies have disputed this approach (28,114).…”

Section: Imaging Strategies In Children With Uti and Vurmentioning

confidence: 99%

Nuclear Medicine in Pediatric Nephro-Urology: An Overview

Mendichovszky

Solar

Smeulders

et al. 2017

Seminars in Nuclear Medicine

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In the context of ante-natally diagnosed hydronephrosis, the vast majority of children with a dilated renal pelvis do not need any surgical treatment, as the dilatation resolves spontaneously with time. Slow drainage demonstrated at Tc-99m-mercaptoacetyltriglycine (MAG3) renography does not necessarily mean obstruction. Obstruction is defined as resistance to urinary outflow with urinary stasis at the level of the pelvic-ureteric junction (PUJ) which, if left untreated, will damage the kidney. Unfortunately this definition is retrospective and not clinically helpful. Therefore, the identification of the kidney at risk of losing function in an asymptomatic patient is a major research goal. In the context of renovascular hypertension a DMSA scan can be useful before and after revascularisation procedures (angioplasty or surgery) to assess for gain in kidney function. Renal calculi are increasingly frequent in children. Whilst the vast majority of patients with renal stones do not need functional imaging, DMSA scans with SPECT and a low dose limited CT can be very helpful in the case of complex renal calculi. Congenital renal anomalies such as duplex kidneys, horseshoe kidneys, crossed-fused kidneys and multi-cystic dysplastic kidneys greatly benefit from functional imaging to identify regional parenchymal function, thus directing further management. Positron emission tomography (PET) is being actively tested in genito-urinary malignancies. Encouraging initial reports suggest that F-18-fluorodeoxyglucose (FDG) PET is more sensitive than CT in the assessment of lymph nodal metastases in patients with genito-urinary sarcomas; an increased sensitivity in comparison to isotope bone scans for skeletal metastatic disease has also been reported. Further evaluation is necessary, especially with the promising advent of PET/MRI scanners. Nuclear Medicine in paediatric nephro-urology has stood the test of time and is opening up to new exciting developments.

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Recurrent urinary tract infections in young children: role of DMSA scintigraphy in detecting vesicoureteric reflux

Abstract: DMSA scan had high overall sensitivity and negative predictive value with a low negative likelihood ratio for ruling out high-grade vesicoureteric reflux on MCUG, which may obviate the need of invasive MCUG along with its associated drawbacks.

Cited by 9 publications

References 28 publications

The Efficacy of Tc-99m DMSA Scintigraphy in Children with Vesicoureteral Reflux Accompanying Frequent Urinary Tract Infection

The Efficacy of Tc-99m DMSA Scintigraphy in Children with Vesicoureteral Reflux Accompanying Frequent Urinary Tract Infection

Urinary Tract Infection in Children

Nuclear Medicine in Pediatric Nephro-Urology: An Overview

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