Screening Young Children with a First Febrile Urinary Tract Infection for High-grade Vesicoureteral Reflux with Renal Ultrasound Scanning and Technetium-99m-labeled Dimercaptosuccinic Acid Scanning

Lee, Ming-Dar; Lin, Chun-Chen; Huang, Fu‐Yuan; Tsai, Tsuen‐Chiuan; Huang, Changjun; Tsai, Jeng-Daw

doi:10.1016/j.jpeds.2008.12.045

Cited by 79 publications

(68 citation statements)

References 31 publications

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“…[13,14] Although the diagnosis of dilating VUR is missed in a small subgroup of children at risk of developing severe kidney damage, some studies have supported this strategy having high sensitivity, specificity, and negative predictive value for predicting clinically significant VUR. [15][16][17] However, conclusions from two meta-analyses have demonstrated that acute-phase DMSA scintigraphy for predicting VUR was not accurate enough in children with fUTI. [18,19] In addition, it should be emphasized that there is no certain distinction between radiologically revealed congenital renal dysplasia and parenchymal inflammatory changes associated with acute pyelonephritis in young children.…”

Section: Discussionmentioning

confidence: 99%

Delayed diagnosis of primary vesicoureteral reflux in children with recurrent urinary tract infections: Diagnostic approach and renal outcomes

Doğan

Koyun

Aksoy

et al. 2018

Turkish Journal of Urology

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Objective: In this study, we aimed to assess renal outcomes of delayed diagnosis of dilating primary vesicoureteral reflux (VUR) following recurrent febrile urinary tract infections (fUTIs) and its diagnostic imaging procedures. Material and methods:The medical records of patients who underwent ultrasonography (US), non-acute dimercaptosuccinic acid (Tc-99mDMSA) scintigraphy and voiding cystourethrography (VCUG), and who were older than 2 years at the time of VUR diagnosis were retrospectively reviewed.Results: A total of 32 children (female, n=27: 84.4%) with a mean age of 7.67±3.34 years at the time of diagnosis of VUR were included in the study. Grade III, IV, V VUR were found in 22%, 69%, and 9% of the patients, respectively. At the time of VUR diagnosis, abnormal US findings were detected in 75% of the cases. Tc-99mDMSA detected abnormalities in 83.9% (7 with a single scar, 7 with multiple lesions, 12 with reduced kidney function) of the patients. Estimated glomerular filtration rate of 3 patients with bilateral grade IV VUR was <75 mL/min/1.73 m 2 . In 5 patients (16%), VUR could not be predicted by US+DMSA scintigraphy (Grade IV VUR in 3 and Grade III in 2 cases ). The sensitivity in predicting VUR was 75.00% , respectively, for US alone and combined US+DMSA. Conclusion:VCUG should be performed routinely in addition to US and non-acute DMSA in all children referred with recurrent fUTIs. Awareness of childhood UTI in public and healthcare personnels should be increased in order to refer these patients at a early stage to pediatric urology and nephrology units.

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Section: Discussionmentioning

confidence: 99%

Delayed diagnosis of primary vesicoureteral reflux in children with recurrent urinary tract infections: Diagnostic approach and renal outcomes

Doğan

Koyun

Aksoy

et al. 2018

Turkish Journal of Urology

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“…18 Evidence to support the use of RUS in VUR is in the setting of initial workup of children with febrile UTI and VUR diagnosis alongside VCUG and DMSA. [7][8][9]19 Additionally, RUS is beneficial as a follow-up imaging modality at discharge and 4 to 6 weeks post-surgical correction of VUR to screen for ureteral obstruction. [7][8][9] The approximate cost of abdominal ultrasound in Alberta is $150 based on a cost to interpret the result by a pediatric radiologist.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9]19 Additionally, RUS is beneficial as a follow-up imaging modality at discharge and 4 to 6 weeks post-surgical correction of VUR to screen for ureteral obstruction. [7][8][9] The approximate cost of abdominal ultrasound in Alberta is $150 based on a cost to interpret the result by a pediatric radiologist. There are additional indirect costs, such as parental time off work, hospital parking and ultrasound technician time, which are more challenging to measure.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9] The RUS was performed and interpreted at the Hospital for Sick Children in Toronto, Ontario, Canada by a pediatric radiologist. The variables collected included demographic data (age, gender and length of follow-up), VUR history, VUR grade, previous renal scars, number of previous UTIs, and UTIs since last visit, dysfunctional voiding symptoms, and concurrent ultrasound findings (i.e., renal growth, change in the grade of hydronephrosis or presence of new renal scarring).…”

Section: Rudzinski Et Almentioning

confidence: 99%

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Does routine ultrasound change management in the follow-up of patients with vesicoureteral reflux?

Rudzinski

Weber

Wildgoose

et al. 2013

CUAJ

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Introduction: Children with vesicoureteral reflux (VUR) usually need a renal ultrasound (RUS). There is little data on the role of follow-up RUS in VUR. We evaluated the impact of follow-up RUS on the change in clinical management in patients with VUR. Methods: We prospectively analyzed children with a previous diagnosis of VUR seen in the outpatient clinic with a routine follow-up RUS within 4 months. Variables collected included: demographic data, VUR history, dysfunctional voiding symptoms and concurrent ultrasound findings. Change in management was defined as addition of new medication, nurse counselling, surgery or further investigations. Results: The study included 114 consecutive patients. The mean patient age was 4.5 years old, mean age of VUR diagnosis was 1.7 years, with average follow-up of 2.8 years. A change in management with stable RUS occurred in 14 patients, in which the change included ordering a DMSA in 9, nurse counselling for dysfunctional voiding in 3, and booking surgery in 2 patients. Change on RUS was seen in 4 patients. Multivariable analysis showed that history of urinary tract infection (UTI) since the last follow-up visit was more significant than RUS findings. Conclusions: The RUS findings in most patients followed for VUR remain stable or with minimal changes. The variable showing a significant effect on change in management in our study was history of UTI since the last follow-up visit rather than RUS findings. The value of follow-up RUS for children with VUR may need to be revisited.

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“…C o n s i d e r a n d o q u e l a s g u í a s d e 1 9 9 9 aseguraban el diagnóstico de RVU en el primer episodio de ITU en todos los pacientes y teniendo en cuenta que la versión de 2011 recomienda omitir la CUGM si la ecografía es normal (hallazgo observable en aproximadamente el 33% de los casos), 12 inferimos que la capacidad diagnóstica de RVU frente a un primer episodio de ITU disminuye al 67%. Con una potencia del 80% y un nivel de confianza de 95%, 21 pacientes por grupo (estudiados en el primer episodio versus los estudiados ante la recurrencia) serían necesarios para evidenciar dicha diferencia de proporciones.…”

Section: Análisis Estadísticounclassified

Diagnóstico de reflujo vesicoureteral según las guías de 1999 y de 2011 del Subcomité de Infección Urinaria de la Academia Americana de Pediatría

et al. 2016

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Screening Young Children with a First Febrile Urinary Tract Infection for High-grade Vesicoureteral Reflux with Renal Ultrasound Scanning and Technetium-99m-labeled Dimercaptosuccinic Acid Scanning

Cited by 79 publications

References 31 publications

Delayed diagnosis of primary vesicoureteral reflux in children with recurrent urinary tract infections: Diagnostic approach and renal outcomes

Delayed diagnosis of primary vesicoureteral reflux in children with recurrent urinary tract infections: Diagnostic approach and renal outcomes

Does routine ultrasound change management in the follow-up of patients with vesicoureteral reflux?

Diagnóstico de reflujo vesicoureteral según las guías de 1999 y de 2011 del Subcomité de Infección Urinaria de la Academia Americana de Pediatría

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