Acute phase 99mTc-dimercaptosuccinic acid scan in infants with first episode of febrile urinary tract infection

Printza, Nikoleta; Farmaki, Evangelia; Piretzi, Kalliopi; Arsos, Georgios; Kollios, Konstantinos; Papachristou, Fotiοs

doi:10.1007/s12519-012-0335-7

Cited by 19 publications

(21 citation statements)

References 30 publications

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“…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.…”

Section: Discussionsupporting

confidence: 91%

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: 91%

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

Zhang

Zhou

et al. 2014

Pediatrics

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“…Our study revealed that most of the DMSA scan results were negative for children who had only one episode of uncomplicated UTI (93.7%). Similar results have been obtained by studies done in other countries [5][6][7]. In conclusion, the conventional practice of recommending DMSA scans following UTI should be modified with an evidence-based protocol.…”

Section: Brief Reportsupporting

confidence: 86%

“…Expected prevalence of abnormalities on DMSA scans was taken as 15% according to the findings of Printza and others [5]. Significance level (alpha error) was taken as 95% and the level of precision as 5%.…”

Section: No 2 June 2016mentioning

confidence: 99%

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Usefulness of 99mTc Dimercaptosuccinic acid scans after the first episode of urinary tract infection in children admitted to the Lady Ridgeway Hospital for Children, Sri Lanka

Pathirana

Samarasinghe

et al. 2016

Ceylon Med. J.

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Abstract99m Tc-DMSA scan is the best investigation to assess renal scarring after urinary tract infection (UTI) in children. The aim of this study was to describe the findings of DMSA scans done six months after the first UTI. A descriptive cross-sectional study was done among 110 boys and 80 girls selected by systematic sampling. Urine culture was positive in 164 (86.3%) children. There was no statistically significant association between the DMSA scan result and gender, family history of UTI (p=1.00), family history of vesico-ureteric reflux (p=1.00), febrile UTI (p=0.134) and positive urine culture (p=1.00).In 93.7% of children DMSA scan was negative. Hence routinely recommending DMSA scans following UTI must be reconsidered.

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“…Acute-phase DMSA scan shows renal changes in 16.3% of infants experiencing their first febrile UTI (3). Clinical studies have demonstrated that dimercaptosuccinic acid (DMSA) scan is significantly more sensitive than either intravenous pyelography (IVP) or ultrasonography (US) in the diagnosis of acute pyelonephritis (4)(5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Prediction of Renal Cortical Involvement Using Serum and Urinary Inflammatory Markers in Children with Febrile Urinary Tract Infection

2017

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Background: Erythrocyte sedimentation rate (ESR), serum C-reactive protein (CRP), urinary β2 microglobulin, antibody-coated bacteria in the urine sediment, and urinary lactic dehydrogenase (LDH) are more traditional tests used to diagnose true pyelonephritis. Acute-phase dimercaptosuccinic acid (DMSA) scan is a sensitive method for diagnosis of true pyelonephritis. Objectives:Defining predictive values of traditional inflammatory serologic parameters, urine analysis indexes, kidney ultrasonography and fever in children with febrile urinary tract infection for predicting renal cortical involvement. Patients and Methods:In a prospective study, 20 children admitted due to febrile urinary tract infection were assessed for renal cortical involvement by Technetium-99 m-labeled dimercapto succinic acid (TC99-DMSA) scan. Body temperature ≥ 39C, white blood cell count ≥ 15000 cell/µL, positive C-reactive protein, erythrocyte sedimentation rate (first hour) ≥ 30 mm/h, presence of proteinuria, severe pyuria or bacteriuria on urine analysis, urine specific gravity ≤ 1010, and renal ultrasonography were used for predicting renal cortical involvement. Sensitivity, specificity, positive and negative predictive values of these variables were measured by specific formula. Results:The highest measured sensitivity was 100% (erythrocyte sedimentation rate ≥ 30 mm/h). Urine specific gravity < 1010 and bacteriuria had the highest (75%) and lowest (20%) specificities respectively. The highest and lowest positive predictive values were 85.7% ( urine specific gravity < 1010) and 57% (proteinuria), whereas the highest and lowest negative predictive values were related to erythrocyte sedimentation rate > 30 mm/h (100%) and proteinuria (11%) respectively. Normal sonography had a low sensitivity for predicting absence of renal involvement (23%). Conclusions:Erythrocyte sedimentation rate ≥ 30 mm/h is a sensitive marker with high negative predictive value for predicting renal involvement in febrile urinary tract infection.

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Acute phase 99mTc-dimercaptosuccinic acid scan in infants with first episode of febrile urinary tract infection

Abstract: Parenchymal damage found in a minority of infants with febrile UTI presented promptly to the hospital. Acute phase DMSA scan should be carried out only in selected patients. An abnormal acute DMSA scan is a moderate predictor for dilated VUR and its ability to exclude VUR is restricted.

Cited by 19 publications

References 30 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

Usefulness of 99mTc Dimercaptosuccinic acid scans after the first episode of urinary tract infection in children admitted to the Lady Ridgeway Hospital for Children, Sri Lanka

Prediction of Renal Cortical Involvement Using Serum and Urinary Inflammatory Markers in Children with Febrile Urinary Tract Infection

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