Screening high-grade vesicoureteral reflux in young infants with a febrile urinary tract infection

Abstract

To screen high-grade VUR in young infants with febrile UTI, US and acute DMSA scan could be performed first. VCUG is only indicated when abnormalities are apparent on either US or DMSA scan or both.

The Role of Renal Ultrasound in Children With Febrile Urinary Tract Infection

“…The present study reveals that US has modest sensitivity (68.4%) and NPV (87.6%) for disclosing grades III-V VUR. This is consistent with previously reported values for detecting high grade VUR [18,28,29].…”

“…Published studies report that the ability of US to detect grades I-V VUR is poor and varies among studies, with a sensitivity of 16-40% and NPV of 25-86% [10,12,14,15]. However, improved detection rates have been reported in children with grades III-V VUR, with a sensitivity of 63-86% and NPV of 70-94% [18,28,29]. The present study reveals that US has modest sensitivity (68.4%) and NPV (87.6%) for disclosing grades III-V VUR.…”

Ultrasound as a Screening Test for Genitourinary Anomalies in Children With UTI

“…Sensitivity has ranged from 18% to 79% and specificity from 41% to 99%, depending on how a "positive" RBUS was defined and what VUR outcome was assessed (eg, any VUR, "dilating VUR," "high-grade VUR"). [6][7][8][9][10][11] Many other groups have reported GU imaging findings among children who have a history of UTI. However, most of these papers have limitations that make it impossible to determine the test characteristics of RBUS; most common is that many studies do not provide sufficient data to directly compare RBUS findings with VCUG findings in individual patients.…”

“…Many studies have similar limitations. 6,7,9,19,24 Other studies have limited generalizability owing to narrow 10,25 or broad [26][27][28] age ranges, or small sample size. 8,[26][27][28] One study looked specifically at the predictive value of ureteral dilation as an isolated finding on RBUS.…”

Urinary Tract Infection in Children: Importance of Proper Diagnosis and Management

“…One reasonable recommendation is that to screen high grade VUR in young infants with febrile UTI, RUS and DMSA scan could be performed first. VCUG is only indicated when abnormalities are apparent on either RUS or DMSA scan or both 20 .…”