Imaging of pyelonephritis

Lavocat, Marie Pierre; Granjon, D.; Allard, Dominique; Gay, Claire; Freycon, Marie Thérèse; Dubois, Francis

doi:10.1007/s002470050091

Cited by 114 publications

(68 citation statements)

References 18 publications

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“…However, most of these papers have limitations that make it impossible to determine the test characteristics of RBUS; most common is that many studies do not provide sufficient data to directly compare RBUS findings with VCUG findings in individual patients. [12][13][14][15][16][17][18][19] Other studies focus on the value of RBUS to predict renal scintigraphic findings (scarring). 13,[20][21][22] Verification bias is a common weakness in the published literature.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound as a Screening Test for Genitourinary Anomalies in Children With UTI

Nelson¹,

Johnson²,

Logvinenko

et al. 2014

Pediatrics

107

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WHAT'S KNOWN ON THIS SUBJECT: Current guidelines recommend renal ultrasound as a screening test after febrile urinary tract infection, with voiding cystourethrogram (VCUG) only if the ultrasound is abnormal. Few studies have evaluated the accuracy of ultrasound as a screening test for VCUG-identified abnormalities. WHAT THIS STUDY ADDS:This study shows that ultrasound is a poor screening test for genitourinary abnormalities identified on VCUG, such as vesicoureteral reflux. Neither positive nor negative ultrasounds reliably identify or rule out such abnormalities. Ultrasound and VCUG provide different, but complementary, information.abstract BACKGROUND: The 2011 American Academy of Pediatrics guidelines state that renal and bladder ultrasound (RBUS) should be performed after initial febrile urinary tract infection (UTI) in a young child, with voiding cystourethrogram (VCUG) performed only if RBUS shows abnormalities. We sought to determine test characteristics and predictive values of RBUS for VCUG findings in this setting. METHODS:We analyzed 3995 clinical encounters from January 1, 2006 to December 31, 2010 during which VCUG and RBUS were performed for history of UTI. Patients who had previous postnatal genitourinary imaging or history of prenatal hydronephrosis were excluded. Sensitivity, specificity, and predictive values of RBUS for VCUG abnormalities were determined. RESULTS:We identified 2259 patients age ,60 months who had UTI as the indication for imaging. RBUS was reported as "normal" in 75%. On VCUG, any vesicoureteral reflux (VUR) was identified in 41.7%, VUR grade .II in 20.9%, and VUR grade .III in 2.8%. Sensitivity of RBUS for any abnormal findings on VCUG ranged from 5% (specificity: 97%) to 28% (specificity: 77%). Sensitivity for VUR grade .III ranged from 18% (specificity: 97%) to 55% (specificity: 77%). Among the 1203 children aged 2 to 24 months imaged after a first febrile UTI, positive predictive value of RBUS was 37% to 47% for VUR grade .II (13% to 24% for VUR grade .III); negative predictive value was 72% to 74% for VUR grade .II (95% to 96% for VUR grade .III).CONCLUSIONS: RBUS is a poor screening test for genitourinary abnormalities. RBUS and VCUG should be considered complementary as they provide important, but different, information. Dr Nelson conceptualized and refined the study design, performed a substantial portion of data collection and interpretation, and drafted the initial manuscript; Dr Johnson contributed substantially to data collection and interpretation, critically reviewed the manuscript, and incorporated revisions from all the authors; Dr Logvinenko performed data analysis and critically reviewed the manuscript; Dr Chow contributed to conceptualization and refinement of the study design and data interpretation and critically reviewed the manuscript; and all authors approved the final manuscript as submitted. Although the new guidelines do not explicitly frame RBUS as a screening test, the guidelines do suggest that the decision to perform VCUG after a first febrile UTI...

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Section: Discussionmentioning

confidence: 99%

Ultrasound as a Screening Test for Genitourinary Anomalies in Children With UTI

Nelson¹,

Johnson²,

Logvinenko

et al. 2014

Pediatrics

107

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“…116,126,148,201 Only six studies provided an adequate description of both the index test and the reference standard. 121,150,155,160,169,183 Eleven studies did not report sufficient information to assess avoidance of test review bias, 116,127,146,148,150,156,157,166,169,201,205 and six did not report sufficient information to assess avoidance of disease progression bias. 116,125,146,155,177,201 The remaining two evaluations of ultrasound techniques used inappropriate reference standard tests of clinical and laboratory diagnosis of APN 211 and computed tomography (CT).…”

Section: Ultrasoundmentioning

confidence: 99%

“…The diagnostic accuracy of ultrasound was assessed in 20 studies. 116,121,[125][126][127]134,146,148,150,[155][156][157]160,166,169,177,183,201,205,211 Renal scintigraphy was the reference standard in 18 of these studies, 116,121,[125][126][127]146,148,150,[155][156][157]160,166,169,177,183,201,205 with acute 99m Tc-DMSA used in 14 of these. Of the 18 ultrasound studies that used an appropriate reference standard, ten did not use an appropriate spectrum of patients, 116,121,127,148,150,[155][156][157]177,…”

Section: Ultrasoundmentioning

confidence: 99%

Clinical effectiveness and cost-effectiveness of tests for the diagnosis and investigation of urinary tract infection in children: a systematic review and economic model

Whiting¹,

Westwood²,

Bojke³

et al. 2006

Health Technol Assess

133

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The results of the systematic review were used to derive an algorithm for the diagnosis of UTI in children under 5. This algorithm represents the conclusions of the review in terms of effective practice. There were insufficient data to propose an algorithm for the further investigation of UTI in children under 5. The quality assessment highlighted several areas that could be improved upon in future diagnostic accuracy studies.

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“…Twelve studies fulfilled the criteria, seven (14 -20) presenting data for children and seven (15,18,(21)(22)(23)(24)(25) for kidneys, with two studies (15,18) giving data for both. One study (15) gave results for scans at two time points, Ͻ6 wk and at later follow-up; the earlier ones are used here.…”

Section: Overviewmentioning

confidence: 99%

Primary Vesicoureteric Reflux as a Predictor of Renal Damage in Children Hospitalized with Urinary Tract Infection

Gordon¹,

Barkovics²,

Pindoria³

et al. 2003

Journal of the American Society of Nephrology

187

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Abstract. Renal parenchymal disease after urinary tract infection (UTI) has been associated with the development of hypertension and renal functional impairment. A systematic literature review and meta-analysis was performed to determine how effectively the finding of primary vesicoureteric reflux (VUR) on micturating cystography (MCU) in children hospitalized with UTI predicted renal parenchymal disease on 99m Technetium-dimercaptosuccinic acid ( 99m Tc-DMSA) scintigraphy. Medline, Embase, and PubMed were use to find reports with original data for children hospitalized with bacteriologically-proven UTI who had undergone both MCU and 99m Tc-DMSA scintigraphy, and which also reported both positive and negative results of these tests. A meta-analysis of likelihood ratios positive and negative for MCU was then performed, including tests for heterogeneity. Twelve valid studies were found, seven with data for 537 children, with a positive 99m Tc-DMSA scan prevalence of 59% overall, and seven studies with data for 1062 kidneys, with a positive 99m Tc-DMSA scan prevalence of 36%. The likelihood ratio positive for MCU was 1.96 (95% CI, 1.51 to 2.54) for children, and 2.34 (1.53 to 3.57) for kidneys. The likelihood ratio negative was 0.71 (0.58 to 0.85) for children and 0.72 (0.61 to 0.86) for kidneys. There was evidence of heterogeneity. The meta-analysis showed that a positive MCU increases the risk of renal damage in hospitalized UTI patients by about 20%, whereas a negative MCU increases the chance of no renal involvement by just 8%. VUR is hence a weak predictor of renal damage in pediatric patients hospitalized with UTI. Physicians should be aware of the limitations of using MCU-detected primary VUR as an effective screening test for renal damage in this population. Furthermore, the pathogenesis of renal damage in such patients is probably complex because it is often detected without demonstrable VUR.

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Imaging of pyelonephritis

Abstract: DMSA scans should be considered as a reference in the detection and follow-up of renal scarring associated with acute urinary tract infection as this technique is more sensitive than US and CT, the latter being unsuitable because it entails radiation exposure and sedation of patients.

Cited by 114 publications

References 18 publications

Ultrasound as a Screening Test for Genitourinary Anomalies in Children With UTI

Ultrasound as a Screening Test for Genitourinary Anomalies in Children With UTI

Clinical effectiveness and cost-effectiveness of tests for the diagnosis and investigation of urinary tract infection in children: a systematic review and economic model

Primary Vesicoureteric Reflux as a Predictor of Renal Damage in Children Hospitalized with Urinary Tract Infection

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