Normal Dimercaptosuccinic Acid Scintigraphy Makes Voiding Cystourethrography Unnecessary after Urinary Tract Infection

Preda, Iulian; Jodal, Ulf; Sixt, Rune; Stokland, Eira; Hansson, Sverker

doi:10.1016/j.jpeds.2007.05.008

Cited by 205 publications

(136 citation statements)

References 20 publications

Supporting

Mentioning

109

Contrasting

Unclassified

Order By: Relevance

“…However, for young children with acute febrile UTI, the sensitivities of DMSA in predicting VUR were reported at different levels by different institutions. [4][5][6] Controversy still exists regarding whether a normal DMSA scan result could obviate MCU. To evaluate the accuracy of an acute DMSA scan in predicting dilating VUR, we retrospectively reviewed the medical records of children (#2 years of age) with febrile UTI between January 2000 and December 2011.…”

Section: Resultsmentioning

confidence: 99%

Accuracy of Early DMSA Scan for VUR in Young Children With Febrile UTI

Zhang

Zhou

et al. 2014

Pediatrics

View full text Add to dashboard Cite

WHAT'S KNOWN ON THIS SUBJECT:The sensitivities of 99m Tcdimercaptosuccinic acid in predicting vesicoureteral reflux reported by different institutions were at different levels for young children with acute febrile urinary tract infection. Tc-dimercaptosuccinic acid (DMSA) scan in predicting dilating vesicoureteral reflux (VUR) among young children with a febrile urinary tract infection (UTI). WHAT THIS STUDY ADDS: METHODS:The medical records of children (#2 years of age), presenting with febrile UTI between January 2000 and December 2011, were retrospectively reviewed. RESULTS:A total of 523 children were included in this study, of whom 397 children (75.9%) had abnormal DMSA results and 178 children (34.0%) were identified as VUR on micturating cystourethrography (MCU). Among all the patients, the number of children with dilating VUR was 151 (28.9%). The rate of abnormal results on DMSA for the dilating VUR group was significantly higher than the rates for the non-VUR and low-grade VUR groups (P , .01). In the ,6 months age group and $6 months age group, the sensitivities of DMSA in predicting dilating VUR were 96.15% and 100.0%, respectively, the negative predictive values were 97.26% and 100.0%, respectively, and the negative likelihood ratios were 0.0911 and 0.0000, respectively. CONCLUSION: For children #2 years of age with a febrile UTI, an acute DMSA scan is valuable in the exclusion of dilating VUR. The likelihood of the presence of dilating VUR on MCU is rather low when the result of DMSA is negative. DMSA should be conducted to assess the need for an MCU. Pediatrics 2014;133:e30-e38 AUTHORS:

show abstract

Section: Resultsmentioning

confidence: 99%

Accuracy of Early DMSA Scan for VUR in Young Children With Febrile UTI

Zhang

Zhou

et al. 2014

Pediatrics

View full text Add to dashboard Cite

show abstract

“…Sensitivity has ranged from 18% to 79% and specificity from 41% to 99%, depending on how a "positive" RBUS was defined and what VUR outcome was assessed (eg, any VUR, "dilating VUR," "high-grade VUR"). [6][7][8][9][10][11] Many other groups have reported GU imaging findings among children who have a history of UTI. 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.…”

Section: Discussionmentioning

confidence: 99%

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

Nelson¹,

Johnson²,

Logvinenko

et al. 2014

Pediatrics

107

View full text Add to dashboard Cite

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...

show abstract

“…[13,14] Although the diagnosis of dilating VUR is missed in a small subgroup of children at risk of developing severe kidney damage, some studies have supported this strategy having high sensitivity, specificity, and negative predictive value for predicting clinically significant VUR. [15][16][17] However, conclusions from two meta-analyses have demonstrated that acute-phase DMSA scintigraphy for predicting VUR was not accurate enough in children with fUTI. [18,19] In addition, it should be emphasized that there is no certain distinction between radiologically revealed congenital renal dysplasia and parenchymal inflammatory changes associated with acute pyelonephritis in young children.…”

Section: Discussionmentioning

confidence: 99%

Delayed diagnosis of primary vesicoureteral reflux in children with recurrent urinary tract infections: Diagnostic approach and renal outcomes

Doğan

Koyun

Aksoy

et al. 2018

Turkish Journal of Urology

View full text Add to dashboard Cite

Objective: In this study, we aimed to assess renal outcomes of delayed diagnosis of dilating primary vesicoureteral reflux (VUR) following recurrent febrile urinary tract infections (fUTIs) and its diagnostic imaging procedures. Material and methods:The medical records of patients who underwent ultrasonography (US), non-acute dimercaptosuccinic acid (Tc-99mDMSA) scintigraphy and voiding cystourethrography (VCUG), and who were older than 2 years at the time of VUR diagnosis were retrospectively reviewed.Results: A total of 32 children (female, n=27: 84.4%) with a mean age of 7.67±3.34 years at the time of diagnosis of VUR were included in the study. Grade III, IV, V VUR were found in 22%, 69%, and 9% of the patients, respectively. At the time of VUR diagnosis, abnormal US findings were detected in 75% of the cases. Tc-99mDMSA detected abnormalities in 83.9% (7 with a single scar, 7 with multiple lesions, 12 with reduced kidney function) of the patients. Estimated glomerular filtration rate of 3 patients with bilateral grade IV VUR was <75 mL/min/1.73 m 2 . In 5 patients (16%), VUR could not be predicted by US+DMSA scintigraphy (Grade IV VUR in 3 and Grade III in 2 cases ). The sensitivity in predicting VUR was 75.00% , respectively, for US alone and combined US+DMSA. Conclusion:VCUG should be performed routinely in addition to US and non-acute DMSA in all children referred with recurrent fUTIs. Awareness of childhood UTI in public and healthcare personnels should be increased in order to refer these patients at a early stage to pediatric urology and nephrology units.

show abstract

Normal Dimercaptosuccinic Acid Scintigraphy Makes Voiding Cystourethrography Unnecessary after Urinary Tract Infection

Cited by 205 publications

References 20 publications

Accuracy of Early DMSA Scan for VUR in Young Children With Febrile UTI

Accuracy of Early DMSA Scan for VUR in Young Children With Febrile UTI

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

Delayed diagnosis of primary vesicoureteral reflux in children with recurrent urinary tract infections: Diagnostic approach and renal outcomes

Contact Info

Product

Resources

About