The Role of Vesicoureteral Reflux in Acute Renal Cortical Scintigraphic Lesion and Ultimate Scar Formation

Oh, Mi Mi; Jin, Myeong Heon; Bae, Jae Hyun; Park, Hong Seok; Lee, Jeong Gu; Moon, Du Geon

doi:10.1016/j.juro.2008.07.067

Cited by 21 publications

(21 citation statements)

References 21 publications

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“…However, an association between urinary tract infection in children with vesicoureteral reflux and renal scarring remains unquestionable (Faust et al, 2009;Jahnukainen et al, 2005;Muinuddin et al, 2008). This was confirmed by recent studies that demonstrated an increase in the risk of renal scarring after acute pyelonephritis in patients with vesicoureteral reflux (Kanellopoulos et al, 2006;Lee et al, 2006;Polito et al, 2006;Oh et al, 2008). Studies by Svensson et al (2005) and Mohanan et al (2008) disclosed that renal scarring was detected less frequently in infants with vesicoureteral reflux and without urinary tract infection than in those with vesicoureteral reflux and urinary tract infection.…”

Section: Reflux Nephropathysupporting

confidence: 54%

“…In study by Ylinen et al (2003) renal scarring was found more frequently in infants in whom vesicoureteral reflux was diagnosed after the first episode of urinary tract infection than in those in whom vesicoureteral reflux was detected antenatally. The risk of acute pyelonephritis and thus renal scarring increases along with grade of vesicoureteral reflux (Arant, 1991;Oh et al, 2008, Shaikh et al, 2010 www.intechopen.com et al, 1992). In the last years, an association between ACE gene polymorphism and development/ progression of RN was demonstrated.…”

Section: Reflux Nephropathymentioning

confidence: 99%

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Post-Inflammatory Nephropathy

Bieniaś¹,

Zajączkowska²,

Borzęcka³

et al. 2011

Urinary Tract Infections

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Section: Reflux Nephropathysupporting

confidence: 54%

Section: Reflux Nephropathymentioning

confidence: 99%

Post-Inflammatory Nephropathy

Bieniaś¹,

Zajączkowska²,

Borzęcka³

et al. 2011

Urinary Tract Infections

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“…This finding strengthens the previous report that VUR is the factor associated with increased risk of scar formation from their initial insult of acute scintigraphic lesions considering other clinical factors. [17,18] Our manuscript has some limitations in the point that every child with VUR had undergone antibiotic prophylaxis which may have affected prevalence of ASL and USF in this group. In accordance with our previous report, VUR and TDT were independent risk factors for acute scintigraphic lesion and ultimate scar formation [17].…”

Section: Discussionmentioning

confidence: 97%

“…The inclusion criteria were fever (body temperature 38 C or greater), positive urine culture and pyuria. The definition of positive urine culture was either growth of microorganisms over 10 5 colonyforming units (CFU)/ml from clean-voided midstream urine or over 10 3 CFU/ml from suprapubic puncture in children with diaper voiding [18]. Any individual with a history of UTI, concurrent congenital urogenital abnormalities or uropathy other than VUR and with known prenatal hydronephrosis were excluded.…”

Section: Methodsmentioning

confidence: 99%

“…The scan was considered to have an acute scintigraphic lesion (acute photon defect) if at least one area of decreased focal or diffuse cortical uptake of DMSA was noted, with the renal outline preserved. If one or more areas of focal renal cortical defect were consistently associated with defects in the renal outline, i.e., little or no DMSA uptake and loss of volume that correlated the previous involved cortex, a renal scar was diagnosed [18].…”

Section: Imaging Studymentioning

confidence: 99%

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

Kim

Park

et al. 2011

Eur J Pediatr

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We assessed the role of therapeutic delay time (TDT) in acute renal cortical scintigraphic lesion (ASL) and ultimate scar formation (USF) in children with first febrile UTI and whether it is affected by the presence of vesico-ureteral reflux (VUR). 230 children, 90 girls and 140 boys with first febrile UTI were included. Radiologic (USG, DMSA, and VCUG), clinical (age, gender, peak fever, therapeutic delay time) and laboratory (CBC with differential count, ANC (absolute neutrophil count), BUN, Creatinine, urine analysis, gram stain, culture, CRP and ESR) variables were analysed. DMSA was performed within 5 days and after six months. VCUG was performed after acute phase of UTI. The differences in TDT according to the presence of ASL, USF and VUR were assessed. And the correlation between ASL or USF with the duration of TDT was assessed. Of 230 patients enrolled, 142 patients had refluxing UTI and 88 patients had non-refluxing UTI. TDT was the risk factor associated with ASL and USF along with presence of VUR. TDT was longer in ASL positive group compared with the ASL negative group. Also USF group showed longer TDT compared with those without USF in both refluxing UTI and non refluxing UTI. The TDT was significantly shorter in USF group with the presence of VUR. Positive linear association was noted between prevalence of ASL and USF and duration of TDT. In conclusion, the impact of UTI on formation of USF may be enhanced by the presence of VUR with shorter duration of TDT.

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Identification of Children and Adolescents at Risk for Renal Scarring After a First Urinary Tract Infection

Shaikh

Craig

Rovers³

et al. 2014

JAMA Pediatr

172

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IMPORTANCE No studies have systematically examined the accuracy of clinical, laboratory, and imaging variables in detecting renal scarring in children and adolescents with a first urinary tract infection. OBJECTIVES To identify independent prognostic factors for the development of renal scarring and to combine these factors in prediction models that could be useful in clinical practice. DATA SOURCES MEDLINE and EMBASE. STUDY SELECTION We included patients aged 0 to 18 years with a first urinary tract infection who underwent follow-up renal scanning with technetium Tc 99m succimer at least 5 months later. DATA EXTRACTION AND SYNTHESIS We pooled individual patient data from 9 cohort studies. MAIN OUTCOMES AND MEASURES We examined the association between predictor variables assessed at the time of the first urinary tract infection and the development of renal scarring. Renal scarring was defined by the presence of photopenia on the renal scan. We assessed the following 3 models: clinical (demographic information, fever, and etiologic organism) and ultrasonographic findings (model 1); model 1 plus serum levels of inflammatory markers (model 2); and model 2 plus voiding cystourethrogram findings (model 3). RESULTS Of the 1280 included participants, 199 (15.5%) had renal scarring. A temperature of at least 39°C, an etiologic organism other than Escherichia coli, an abnormal ultrasonographic finding, polymorphonuclear cell count of greater than 60%, C-reactive protein level of greater than 40 mg/L, and presence of vesicoureteral reflux were all associated with the development of renal scars (P Յ .01 for all). Although the presence of grade IV or V vesicoureteral reflux was the strongest predictor of renal scarring, this degree of reflux was present in only 4.1% of patients. The overall predictive ability of model 1 with 3 variables (temperature, ultrasonographic findings, and etiologic organism) was only 3% to 5% less than the predictive ability of models requiring a blood draw and/or a voiding cystourethrogram. Patients with a model 1 score of 2 or more (21.7% of the sample) represent a particularly high-risk group in whom the risk for renal scarring was 30.7%. At this cutoff, model 1 identified 44.9% of patients with eventual renal scarring. CONCLUSIONS AND RELEVANCE Children and adolescents with an abnormal renal ultrasonographic finding or with a combination of high fever (Ն39°C) and an etiologic organism other than E coli are at high risk for the development of renal scarring.

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The Role of Vesicoureteral Reflux in Acute Renal Cortical Scintigraphic Lesion and Ultimate Scar Formation

Cited by 21 publications

References 21 publications

Post-Inflammatory Nephropathy

Post-Inflammatory Nephropathy

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

Identification of Children and Adolescents at Risk for Renal Scarring After a First Urinary Tract Infection

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