Risk factors in the development of early technetium‐99m dimercaptosuccinic acid renal scintigraphy lesions during first urinary tract infection in children

Abstract

Fernández-Menéndez JM, Málaga S, Matesanz JL, Solís G, Alonso S, Pérez-Méndez C. Risk factors in the development of early technetium-99m dimercaptosuccinic acid renal scintigraphy lesions during first urinary tract infection in children. Acta Paediatr 2003; 92: 21-26. Stockholm. ISSN 0803-5253Aim: To establish the variables that correlate with uptake defects in dimercaptosuccinic acid (DMSA) scintigraphy performed in the acute phase of a first episode of urinary tract infection (UTI). Methods: A prospective observational study was conducted in a cohort of 158 consecutive children with a first episode of symptomatic UTI. The therapeutic delay time (TDT) was recorded. DMSA scintigraphy was performed in all children and voiding cystourethrography in 150 of them. Results: 85% of the patients were younger than 2 y. Mean TDT was 33.5 h. The aetiological agent was Escherichia coli in 140 children. DMSA scintigraphy was normal in 81. Vesicoureteric reflux was detected in 33. After a multivariate logistic regression analysis the following variables were retained in the final model: TDT !48 h, growth of bacteria other than E. coli, percentage of polymorphonuclear cells !60% and C-reactive protein !30 mg l À1 .Conclusion: TDT !48 h, bacteria other than E. coli, percentage of polymorphonuclear cells !60% and CRP !30 mg l À1 influence the findings detected in the DMSA scintigraphy performed in the acute phase of a first episode of UTI.

Diagnosis and Management of an Initial UTI in Febrile Infants and Young Children

“…The 1999 technical report cited evidence that febrile UTIs in children less 44 demonstrated an increased risk of scarring with delayed treatment. Children whose treatment is delayed more than 48 hours after onset of fever may have a more than 50% higher risk of acquiring a renal scar.…”

“…Data on the prevalence of VUR among children without a history of UTI do not (1997) Cross-sectional study of children Ͻ5 y of age with first UTI 272 28 McDonald et al 52 (2000) Retrospective chart review of children with VCUG after UTI 176 19 Oostenbrink et al 53 (2000) Cross-sectional study of children Ͻ5 y of age with first UTI 140 26 Mahant et al 54 (2001) Retrospective chart review of children with VCUG after UTI 162 22 Mahant et al 55 (2002) Retrospective review of VCUG in children Ͻ5 y of age admitted with first UTI 162 22 Chand et al 56 (2003) Retrospective review of VCUG or radionuclide cystogram in children Ͻ7 y of age 15 504 35 Fernandez-Menendez et al 44 (2003) Prospective cohort study of 158 children Ͻ5 y of age (85% Ͻ 2 y) with first UTI 158 22 Camacho et al 41 (2004) Prospective cohort study of children 1 mo to 12 y of age (mean age: 20 mo) with first febrile UTI Figure 3 shows the prevalence of VUR plotted as a function of the midpoint of each age stratum.…”

“…41,44,51,56,57,62,63 The distributions of different reflux grades among children who had VUR are shown in Fig 4. There is significant variability in the relative predominance of each reflux grade, but grades II and III consistently are the most common. With the exception of the study by Camacho et al, 41 all studies showed grades IV and V to be the least frequent, and grade V accounted for 0% to 5% (weighted average: 3%) of reflux.…”

The impact of therapeutic delay time on acute scintigraphic lesion and ultimate scar formation in children with first febrile UTI

“…Their true importance of urinary tract infection (UTI) lies in their ability to result in permanent renal damage which causes severe sequelae such as hypertension, renal failure, and end-stage renal disease [4,21]. Although the damage in the renal parenchyma is related, among other factors, to the time of evolution of the disease up until an effective antibiotic treatment is started, the time interval from which the renal lesion can become irreversible is not well documented, yet [4]. Also, previously we have identified therapeutic delay time as the predictive factor for acute scintigraphic lesion (ASL) and ultimate scar formation (USF) along with presence of VUR [17].…”

Febrile Urinary Tract Infections in Children Less Than 2 Years of Age

“…Delayed diagnosis and/or inadequate treatment of AP may increase the risk of possible permanent kidney damage (Fernández-Menéndez et al 2003). On the other hand, a false diagnosis of AP may lead to invasive diagnostic imaging and unnecessary treatment without any benefit to the patient (Anon 1999).…”