Cortical scintigraphy in the evaluation of renal parenchymal changes in children with pyelonephritis

Benador, Daivy; Benador, Nadine; Slosman, Daniel O.; Nusslé, D; Mermillod, Bernadette; Girardin, Éric

doi:10.1016/s0022-3476(94)70248-9

Cited by 207 publications

(135 citation statements)

References 20 publications

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“…[3][4][5] It is imperative that physicians identify these children to institute early treatment, work-up of their urinary tracts, and provide follow-up.…”

Section: Abstract Objective Comparison Of Rapid Tests and Screeningmentioning

confidence: 99%

Screening for Urinary Tract Infection in Infants in the Emergency Department: Which Test Is Best?

et al. 1998

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ABSTRACT. Objective. Comparison of rapid tests and screening strategies for detecting urinary tract infection (UTI) in infants.Methods. Cross-sectional study conducted in an urban tertiary care children's hospital emergency department and clinical laboratories of 3873 infants <2 years of age who had a urine culture obtained in the emergency department by urethral catheterization; results of urine dipstick tests for leukocyte esterase or nitrites, enhanced urinalysis (UA) (urine white blood cell count/mm 3 plus Gram stain), Gram stain alone, and dipstick plus microscopic UA (white blood cells and bacteria per high-powered field) compared with urine culture results (positive urine results defined as >10 4 colony-forming units per milliliter of urinary tract pathogen) for each sample. Cost comparison of 1) dipstick plus culture of all urine specimens versus 2) cell count ؎ Gram stain of urine, culture only those with positive results.Results. The enhanced UA was most sensitive at detecting UTI (94%; 95% confidence interval: 83,99), but had more false-positive results (16%) than the urine dipstick or Gram stain (3%). The most cost-effective strategy was to perform cultures on all infants and begin presumptive treatment on those whose dipstick had at least moderate (؉2) leukocyte esterase or positive nitrite at a cost of $3.70 per child. With this strategy, all infants with UTI were detected. If the enhanced UA was used to screen for when to send the urine for culture, 82% of cultures would be eliminated, but 4% to 6% of infants with UTI would be missed and the cost would be higher ($6.66 per child).Conclusion. No rapid test can detect all infants with UTI. Physicians should send urine for culture from all infants and begin presumptive treatment only on those with a significantly positive dipstick result. The enhanced UA is most sensitive for detecting UTI, but is less specific and more costly, and should be reserved for the neonate for whom a UTI should not be missed at first visit. Pediatrics 1998;101(6). URL: http://www.pediatrics. org/cgi/content/full/101/6/e1; urinalysis, Gram stain, dipstick, UTI, rapid screening, febrile infants.ABBREVIATIONS. UTI, urinary tract infection; ED, emergency department; WBC, white blood cells; UA, urinalysis; LE, leukocyte esterase; CFU/mL, colony forming units per milliliter; CI, confidence interval. R ecent research has indicated that the prevalence of urinary tract infection (UTI) in febrile young children in the emergency department (ED) is ϳ3% to 5%, and in some groups, as high as 30%.1,2 Additionally, recent use of nuclear renal scans has indicated that the majority of febrile young children with UTI have pyelonephritis, putting them at risk for renal scarring and the possible long-term sequelae of hypertension and chronic renal failure. [3][4][5] It is imperative that physicians identify these children to institute early treatment, work-up of their urinary tracts, and provide follow-up.Although there are several screening tests for UTI, there has been no prospective clinical...

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“…[3][4][5] It is imperative that physicians identify these children to institute early treatment, work-up of their urinary tracts, and provide follow-up.…”

Section: Abstract Objective Comparison Of Rapid Tests and Screeningmentioning

confidence: 99%

Screening for Urinary Tract Infection in Infants in the Emergency Department: Which Test Is Best?

et al. 1998

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“…4 The clinical parameters and inflammatory markers, which primarily have been used as indices for the differentiation of lower from upper UTI, are fever, age, reflux, leukocytes and/or neutrophil count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), N-acetyl-␤-glucosaminidase (NAG), and b 2 microglobulin. Several studies [5][6][7][8][9][10][11][12] tried to correlate these parameters with the UTI site but the results were rather conflicting.…”

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confidence: 99%

Polymorphonuclear Elastase as a Diagnostic Marker of Acute Pyelonephritis in Children

Fretzayas¹,

Moustaki²,

Gourgiotis³

et al. 2000

Pediatrics

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ABSTRACT. Objective. Experimental evidence suggests that neutrophils and their metabolites play an important role in the pathogenesis of pyelonephritis. The aim of this study was to investigate the diagnostic value of polymorphonuclear elastase-a 1 -antitrypsin complex (E-a 1 -Pi) for the detection of acute pyelonephritis in children.Methods. Eighty-three patients, 29 boys and 54 girls, 25 days to 14 years of age, with first-time symptomatic urinary tract infection were prospectively studied. Fiftyseven healthy children served as controls. Dimercaptosuccinic acid (DMSA) scan and voiding cystourethrography were performed in all patients. Plasma and urinary E-a 1 -Pi, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), neutrophil count, urinary N-acetyl-␤-glucosaminidase (NAG), N-acetyl-␤-glucosaminidase b (NAG b), and creatinine levels were measured in all patients on admission and 3 days after the introduction of antibiotics. The same markers were also measured in the control subjects.Results. Planar DMSA scintigraphy demonstrated changes of acute pyelonephritis in 30 of 83 children (group A). It was normal in the remaining 53 children (group B). The sex and age distributions were not significantly different between the 2 groups, as well as between the patients and the control subjects (group C). Nineteen of the 53 children with a normal DMSA had body temperature >38°C, whereas all but 4 children with abnormal DMSA had temperature >38°C. Therefore, the temperature was significantly different between these 2 groups. The sensitivity and specificity of fever (>38°C) as an indicator of renal involvement based on isotopic findings were 86% and 64%, respectively. Given the significant number of the febrile children with normal DMSA scintiscans, group B was subdivided into B 1 with 19 febrile children (14 boys and 5 girls) and B 2 with 34 children whose body temperature was below 38°C (8 boys and 26 girls). The sex and age distribution was significantly different between groups B 1 and B 2 . The mean age of group B 1 was .78 years (range: 28 days to 9 years; median: .25 years; standard deviation: 2.1). All but 1 child in this group were younger than 1 year of age. In contrast, in group B 2 , there were only 4 infants, the remaining 30 children were older than 2.5 years (mean age: 6 years; median: 7 years; standard deviation: 3.5; range: 34 days to 12 years). The mean duration of fever before hospital admission was 2.8 days for group A and 1.8 days for group B 1 . This difference was not statistically significant. Similarly, body temperature was not significantly different between these 2 groups. The distribution of plasma E-a 1 -Pi values was normal in the control subjects. The sensitivity and specificity of plasma E-a 1 -Pi, as an indicator of renal involvement, were 96% and 50%, respectively, taking the 95th percentile of the reference range as a cutoff value. However, considering as a cutoff value the level of 72 g/dL (95th percentile of group B 2 ), its sensitivity and specificity were 74% and 86%, resp...

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“…Около 70% младенцев и детей в качестве первого эпи-зода фебрильной ИМВП имеют пиелонефрит, и почечные рубцы (т. е. очаги склероза в почечной ткани) выявляются в дальнейшем у 15-30% из них [35][36][37][38]. При своевре-менном адекватном лечении у большинства младенцев и детей быстро наступает выздоровление без серьезных долгосрочных последствий, но небольшая часть пациен-тов все-таки подвержена риску рецидивирования, про-грессирующего почечного повреждения.…”

Section: прогнозunclassified

Urinary Tract Infection in Children

Маргиева¹,

Komarova²,

Костюшина³

et al. 2014

Pediatr. farmakol.

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путей, этиология, патогенез, клинические проявления, диагностика, лейкоцитурия, бактериурия, сбор мочи, лечение, антибактериальная терапия, профилактика, прогноз, новорожден-ные, младенцы, дети. (Педиатрическая фармакология. 2014; 11 (4): 124-128) Urinary Tract Infection in Children ВВЕДЕНИЕИнфекции мочевыводящих путей (ИМВП) -ведущая причина тяжелых бактериальных инфекций у младен-цев; наблюдаются у 7% детей младше 6 мес жизни и у 5% в возрасте от 6 до 24 мес [1]. ИМВП в период детства переносят в среднем до 10% девочек и 3% маль-чиков. Пузырно-мочеточниковый рефлюкс (ПМР) выяв-ляют после эпизода ИМВП, особенно у новорожденных и младенцев (в 36-49% случаев). В возрасте до 6 мес не наблюдается различий в частоте встречаемости ПМР у мальчиков и девочек [2,3]. ИМВП делят на осложнен-ные, протекающие с лихорадкой (чаще всего пиелонеф-рит), и неосложненные -без лихорадки (чаще инфек-ция нижних мочевыводящих путей). ЭТИОЛОГИЯ И ПАТОГЕНЕЗСреди возбудителей инфекций мочевыводящих путей у детей преобладает грамотрицательная фло-ра, при этом около 90% приходится на инфицирова-ние бактериями Escherichia coli. Грамположительные

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Cortical scintigraphy in the evaluation of renal parenchymal changes in children with pyelonephritis

Cited by 207 publications

References 20 publications

Screening for Urinary Tract Infection in Infants in the Emergency Department: Which Test Is Best?

Screening for Urinary Tract Infection in Infants in the Emergency Department: Which Test Is Best?

Polymorphonuclear Elastase as a Diagnostic Marker of Acute Pyelonephritis in Children

Urinary Tract Infection in Children

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