An audit of RCP guidelines on DMSA scanning after urinary tract infection

Abstract

Aim-To assess the outcome of imaging investigations carried out in children with urinary tract infection (UTI), to compare the investigations with national guidelines, and to assess the impact on management. Methods-Retrospective review of inpatients and outpatients, aged 0-12 years, referred to the University Hospital of Wales Healthcare Trust between February 1997 and January 1998 with UTI. All children without bacterial evidence of UTI and children previously investigated for antenatal urological anomalies, major congenital anomalies, or UTI were excluded. Results-A total of 164 children (51 boys, 113 girls) were included. Thirteen of 56 infants (23%) and 82/108 older children (76%) were diagnosed at home over one year. The prevalence of dilatation on ultrasound was 8%, renal scarring on dimercaptosuccinic acid (DMSA) scan was 11%, and vesicoureteric reflux (VUR) was 34% when investigations were carried out following guidelines published by the Royal College of Physicians. In children aged 1-6 years, the prevalence of scarring was 1/54 (2%) in those treated at home and 6/18 (33%) in inpatients. Conclusion-The low yield of positive results and lack of evidence of impact on management indicate that DMSA scanning, with all the implications of isotope exposure, intravenous injection, staV time, psychological trauma, and expense, could be omitted in children over 1 year with first simple UTI not suYciently ill to be admitted to hospital. The low rate of detection of UTI in primary care in infants may represent under diagnosis.

Primary Vesicoureteric Reflux in Children Between 1 Month and 12 Years With Urinary Tract Infection Admitted in a Tertiary Care Hospital

“…As age increased the proportion decreased to 29% in 3-5 years of age and to 15% over 5 years. The results were similar to the study conducted by Deshpande PV et al 13 In his study 34% children under 1 year presented with VUR and 20% of children were found to have VUR on VCUG in between 1-6 years of age. On analyzing the sex distribution of children with VUR, we found that among first UTI there is not much difference in distribution of VUR among males and females.…”

Risk factors of renal scars in children with acute pyelonephritis

“…6,7 Also, most of the pediatric nephrologists prefer to rely on clinical and biological findings in case of complicated UTI rather than scintigraphy. 8,9 However, it sometimes happens that clinical findings and equivocal urine cultures do not favor diagnosis, even though the patient may already have UTI and renal damage. 10,11 This prospective clinical study was carried out to indicate any correlation between the incidence of renal scarring following acute pyelonephritis and previously well-known risk factors such as vesicoureteral reflux (VUR), age and recurrent urinary tract infections.…”

“…Only 16 (20%) children had neurogenic bladder. The median duration of fever was 3 days (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. Other paraclinical findings were as follows: CRP level of more than 6 mg/dL was reported in 61 (76.2%) children; leukocytosis in 42 (52.5%); and positive culture for Escherichia coli was obtained from 69 (86.2%) and the rest of the patients had other urinary microbial profiles.…”

DMSAs after UTI---scan more children, not less

“…E ditor ,—Deshpande and Verrier Jones have recently concluded that it is not worth undertaking dimercaptosuccinic acid (DMSA) scans in children over 1 year of age who present with a “simple” urinary tract infection (UTI) 1. Their argument has three strands.…”