Diagnostic performance of contrast-enhanced ultrasound for acute pyelonephritis in children

Abstract

The objective of our study was to evaluate the performance of renal contrast-enhanced ultrasound (CEUS) against the 99m-labeled dimercaptosuccinic acid (DMSA) scan and computed tomography (CT) in children for the diagnosis of acute pyelonephritis. We included children who underwent both renal CEUS and the DMSA scan or CT. A total of 33 children (21 males and 12 females, mean age 26 ± 36 months) were included. Using the DMSA scan as the reference standard, the sensitivity, specificity, positive predictive value, and negative predictive value of CEUS was 86.8%, 71.4%, 80.5%, and 80.0%, respectively. When CT was used as the reference standard, the sensitivity, specificity, positive predictive value, and negative predictive value of CEUS was 87.5%, 80.0%, 87.5%, and 80.0%, respectively. The diagnostic accuracy of CEUS for the diagnosis of acute pyelonephritis was 80.3% and 84.6% compared to the DMSA scan and CT, respectively. Inter-observer (kappa = 0.54) and intra-observer agreement (kappa = 0.59) for renal CEUS was moderate. In conclusion, CEUS had good diagnostic accuracy for diagnosing acute pyelonephritis with moderate inter- and intra-observer agreement. As CEUS does not require radiation or sedation, it could play an important role in the future when diagnosing acute pyelonephritis in children.

CT and MRI in Urinary Tract Infections: A Spectrum of Different Imaging Findings

“…Uropathogenic Escherichia coli (UPEC) is the commonest causative organism for both complicated and uncomplicated UTIs [ 5 , 6 , 7 , 8 ]. Undetected and untreated acute pyelonephritis may lead to renal hypertension, renal scarring, and even renal failure [ 9 ].…”

Clinical manifestations, laboratory markers, and renal ultrasonographic examinations in 1-month to 12-year-old Iranian children with pyelonephritis: a six-year cross-sectional retrospective study

“…It has been reported that the annual cost of treating this disease in France and the US was about €58 million and $2.47 billion, respectively [ 2 , 3 ]. In childhood, this disease usually occurs in boy infants due to congenital anomalies of kidneys and urinary tract, while AP is observed in girls at older ages [ 4 – 6 ]. Escherichia coli is the main responsible pathogen for AP.…”

“…The renal scarring significantly develops the risk of hypertension, proteinuria, vesicoureteral reflux (VUR), chronic kidney disease, and end-stage renal disease [ 9 , 10 ]. Since renal scarring is observed in 37% of AP children after two years from the infection onset, the rapid diagnosis and implementation of effective therapeutic measures are necessary to manage this disease among children [ 4 , 11 – 13 ].…”

Clinical Manifestations, Laboratory Markers, and Renal Ultrasonographic Examinationsin 1-month to12-year-old Iranian Children with Pyelonephritis: A Six-year Cross-sectional Retrospectivestudy

“…It has beenreported that the annual cost to treat this disease in France and the US respectively was about €58 million and $2.47 billion [2,3]. In childhood, this disease commonly occurs in boy infants due to congenital anomalies of the kidneys and urinary tract, while AP is observed in girls at older ages [4][5][6]. Escherichia coli is the main responsible pathogen for AP, which is often associated with severe in ammation and short-term (such as fever, dysuria, and ank pain) and long-term (irreversible renal scarring (RS)) morbidities [7,8].…”

“…The RS signi cantly accelerates the risk development of hypertension, proteinuria,vesicoureteral re ux (VUR), chronic kidney disease, and end-stage renal disease [9,10]. Since about 37% of children with AP after two years from the infection onset showed renal scarring, the rapid diagnosis and the implementation of effective therapeutic measures are necessary to manage this disease among children [4,[11][12][13].…”