Improved ultrasound detection of renal scarring in children following urinary tract infection

Barry, B.P.; Hall, Nigel; Cornford, Eleanor; Broderick, N.; Somers, John; Rose, D H

doi:10.1016/s0009-9260(98)80317-6

Cited by 43 publications

(41 citation statements)

References 21 publications

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“…These findings support the previous studies those worked with large number of study population. (4,17,18) That indicated disagreement between US and DMSA in the detection of renal scarring.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Agreement between 99mTc-DMSA Renal Scan and Ultrasonography in the Evaluation of Renal Pathology in Children with Recurrent urinary tract infection

Jahan

Begum

Parveen

et al. 2017

Bangladesh J. Nuclear Med.

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Imaging of urinary tract plays a very important role in children with recurrent urinary tract infection (UTI).Various imaging techniques are used and the imaging protocol in children with UTI continues to be a subject of debate. Most authors recommended combination of imaging. The children with recurrent urine infection may be at increased risk of renal parenchymal scarring, hypertension, impaired renal function and end stage renal disease. But early diagnosis and timely proper treatment has an excellent prognosis. 99m-Tc-dimercaptosuccinic acid (DMSA) renal scan and Ultrasonography (US) are routinely performed studies in children with recurrent UTI. If there is agreement between these two investigation procedures, they will be interchangeable, which will benefit the patient by one procedure instead of two. This will be less time consuming and cost effective. The overall accuracy of US for the evaluation of focal scarring of right and left kidney were 89.4% and 78.8% respectively. For the evaluation of diffuse scarring the overall accuracy of US were 92.9% and 97.6% for the right and left kidney respectively. Therefore, in the evaluation of renal scarring the accuracy of US was underestimated by using DMSA scan as a gold standard.In the evaluation of kidney size, position and presence of hydronephrosis, both DMSA and US can be interchangeable. Whereas DMSA was underestimated comparing to US in the evaluation of mild pelvicaliceal dilatation. On the other hand DMSA renal scan is more sensitive and specific for detecting cortical scaring compared to the US. In light of present study, both DMSA scan and US are recommended in the combination for complete evaluation of renal abnormalities in recurrent UTI.

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Section: Discussionmentioning

confidence: 99%

Assessment of Agreement between 99mTc-DMSA Renal Scan and Ultrasonography in the Evaluation of Renal Pathology in Children with Recurrent urinary tract infection

Jahan

Begum

Parveen

et al. 2017

Bangladesh J. Nuclear Med.

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“…Sonographic criteria for renal scarring included renal contour lobulation, renal parenchymal thinning, increased renal parenchymal echo, and decreased renal size (7,8).…”

Section: Methodsmentioning

confidence: 99%

Comparison between Tc-99m DMSA and Renal Ultrasonography for the Evaluation of Renal Scarring and Function Loss in Children with Spina Bifida

Özgönenel¹,

Karalök²,

Günay³

et al. 2017

Istanbul Med J

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Spina bifida (SB) refers to a wide range of neural tube defects, a neuro-urological disease affecting the spine and spinal cord. With a marked geographic and ethnic variation, SB has an incidence of 1-5 cases per 1000 live births. In Turkey, the incidence is 3 per 1000 live births (1), and in the eastern region of Turkey, it is 2.2 per 1000 live births (2). The basic urological problem in SB is neurogenic bladder dysfunction, resulting in urinary tract infections (UTI), incontinence, vesicoureteral reflux (VUR), hydronephrosis, chronic kidney disease (CKD), hypertension, and end-stage renal failure (3). The goal of treatment is to reduce bladder pressure and minimize urine stasis, thus preventing recurrent febrile UTI and consequent function loss. Patients should be followed up regularly against late referral because SB management is a dynamic and long-lasting process for a life time, and patient selection for aggressive treatment may prevent renal parenchymal deterioration (4).Although renal ultrasonography (US) is used to demonstrate renal anomalies, urinary tract dilatation, signs of neurogenic bladder, renal scarring, and presumed function of the kidney, Tc99m DMSA scintigraphy is the best for detecting renal parenchymal defects and demonstrating renal function loss with decreased differential function of the kidney. Single defects resulting in a localized deformity of renal outlines are the result of scarring and show no improvement on subsequent studies. The total renal Dimercaptosuccinic acid (DMSA) uptake is a measure of individual renal function (5). Follow-up studies with scintigraphy and US are conducted to confirm the resolution of pyelonephritic defect(s), evaluation of cortical scarring, and function loss. Patients with scarring are periodically followed up for assessment of progressive renal insufficiency. Tc-99m DMSA scintigraphy demonstrates approximately twice as many defects as renal US in the normal population (6). We hypothesized that this proportion may increase in SB patients because SB patients usually have rotoscoliosis, obesity, renal position anomalies, and intestinal gas distention that may corrupt the imaging quality of US, whereas these imaging difficulties do not affect the imaging quality of Tc-99m DMSA scintigraphy. We studied the efficiency of Tc-99m DMSA scintigraphy and renal US in the detection of renal scarring and function loss in children with SB. Comparison between Tc-99m DMSA and Renal Ultrasonography for the Evaluation of Renal Scarring and Function Loss in Children with Spina BifidaObjective: We aimed to compare the sensitivity of ultrasonography (US) and Dimercaptosuccinic acid (DMSA) scintigraphy in evaluating renal scarring and kidney function in children with spina bifida (SB). Methods:The study group comprised 100 patients (51 boys and 49 girls) with SB who underwent renal US and DMSA scintigraphy. The median age was 2 years (range: 6 months -23 years). Renal US scans were performed by applying standard protocols. Subsequently, DMSA scintigraphy was performed to e...

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“…Isso se deveu ao fato de o trabalho ser retrospectivo e de período longo como observado em outros estudos; 11,14 também a CI está sendo, desde 1998, o método preferido de avaliação no Serviço pelas suas vantagens de maior sensibilidade e menor exposição à irradiação das gônadas. 4,6,7 O exame controle pela UCM ou CI foi realizado em intervalos de 12 a 24 meses. O intervalo de tempo entre o primeiro e o último exame para avaliação do desaparecimento do RVU foi de 12 a 60 meses (média 32,4 ± 13,2 meses); 20 realizaram UCM (tempo médio = 32,4 ± 13,2 meses) e 14 a CI (tempo médio = 31,2 ± 12,0 meses).…”

Section: Estudo Por Imagemunclassified

“…11,14 No presente trabalho o desaparecimento do RVU ocorreu em todos os meninos; esse fato pode estar associado ao diagnóstico do RVU realizado no primeiro ano de vida nesses pacientes 20,24 ou da prevalência do RVU de grau I ou II unilateral. 7,11,16,20,22 O grau do RVU tem influência sobre o seu desaparecimento. O período para a cura espontânea do refluxo é maior no RVU de graus maiores.…”

Section: Rvu Bilateral Rvu Unilateralunclassified

“…6 Um estudo prospectivo relatou correlação de 70% entre CI e UCM, em 23% a CI foi positiva e UCM negativa e em 7% a UCM revelou refluxo de grau leve e a CI foi normal. 7 A freqüência com que se diagnostica o RVU na criança varia inversamente com a idade. 8 O refluxo associado à infecção urinária é comum em crianças jovens; foi observado em 70% de crianças menores de um ano, 25% das menores de quatro anos, 15% das menores de 12 anos e 5% dos adultos.…”

Section: Introductionunclassified

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Freqüência de desaparecimento do refluxo vésico-ureteral de graus I a III em pacientes pediátricos

Macedo¹,

Riyuzo²,

Bastos³

2004

Rev. Bras. Saude Mater. Infant.

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Objectives: to evaluate the frequency of disappearance of primary vesicoureteral reflux (VUR) grade I to III in children and correlate with patient's age at diagnosis, sex, grade and laterality.Methods: a retrospective study of 34 children with VUR detected by voiding cystourethrography (VCU). Five patients were boys (median of age: one year and six months) and 29 were girls (median of age: three years). Control exams by VCU or IC were made in performed 12 to 24 months. Kaplan-Meier survival curves were used for analysis.Results: VUR cessation was observed in 52.9% of patients. Comparing age it was not observed statistic difference. VUR cessation occurred in a median of 24 months in boys and 60 months in girls. There was statistic difference between sex (p = 0.02). VUR cessation occurred in 80% of patients with grade I (median: 25.5 months), 66.6% grade II (median: 48 months), 40% grade III (median: 60 months), in 21% of bilateral (median: 48 months) and 75% of unilateral VUR (median: 28.5 months). There was statistic difference between the grade (p = 0.02) and laterality (p = 0.05) of the VUR.Conclusions: VUR cessation occurred in grade I or II and unilateral, in boys, Key words Vesico ureteral reflux, EvoluçãoResumo Objetivos: avaliar a freqüência do desaparecimento do refluxo vésico-ureteral (RVU) primário de graus I a III em crianças e correlacionar com idade no diagnóstico, sexo, grau e lateralidade.Métodos: estudo retrospectivo de 34 crianças com RVU diagnosticado por uretrocistografia miccional (UCM). Cinco pacientes eram meninos (mediana: um ano e seis meses) e 29 meninas (mediana: três anos) O exame controle pela UCM ou cistografia foi realizado em intervalos de 12 a 24 meses. Na análise das variáveis utilizou-se a curva de sobrevida de KaplanMeier.Resultados: o desaparecimento do RVU ocorreu em 52,9% dos pacientes. Comparando faixas etárias não houve diferença estatística. Nos meninos o desaparecimento do RVU ocorreu na mediana de 24 meses e nas meninas, de 60 meses. Houve diferença estatís-tica entre os sexos (p = 0,02). Houve desaparecimento do RVU em 80% dos pacientes com RVU de grau I (mediana: 25,5 meses), 66,6% de grau II (mediana: 48 meses) 40% de grau III (mediana: 60 meses); em 21% no bilateral (mediana: 48 meses) e 75% no unilateral (mediana: 28,5 meses). Houve diferença estatística entre os graus de RVU (0,02) e lateralidade (p = 0,05).Conclusões: o desaparecimento do RVU ocorreu no sexo masculino, nos graus I ou II e unilateral. Refluxo vésico-ureteral, Evolução Palavras-chave

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Improved ultrasound detection of renal scarring in children following urinary tract infection

Cited by 43 publications

References 21 publications

Assessment of Agreement between 99mTc-DMSA Renal Scan and Ultrasonography in the Evaluation of Renal Pathology in Children with Recurrent urinary tract infection

Assessment of Agreement between 99mTc-DMSA Renal Scan and Ultrasonography in the Evaluation of Renal Pathology in Children with Recurrent urinary tract infection

Comparison between Tc-99m DMSA and Renal Ultrasonography for the Evaluation of Renal Scarring and Function Loss in Children with Spina Bifida

Freqüência de desaparecimento do refluxo vésico-ureteral de graus I a III em pacientes pediátricos

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