Clinical value of late DMSA scan in predicting vesicoureteral reflux in children with febrile urinary tract infection
Yıl: 2020 Cilt: 27 Sayı: 3 Sayfa Aralığı: 733 - 737 Metin Dili: İngilizce DOI: 10.5455/annalsmedres.2020.01.033 İndeks Tarihi: 20-10-2020
Clinical value of late DMSA scan in predicting vesicoureteral reflux in children with febrile urinary tract infection
Öz: Aim: To assess the usefulness of late dimercaptosuccinic acid (DMSA) renal scans in revealing high-grade vesicoureteral reflux(VUR).Material and Methods: Between July 2015 and December 2016, medical records of 112 patients who were admitted with febrileurinary tract infections (fUTIs) were retrospectively reviewed. The demographic information of the patients, and follow-up imaging[ultrasonography (USG), DMSA renal scans, and voiding cystourethrography] data were reviewed.Results: Of the 112 patients, 82 patients (73.2%) were female, 30 were male (26.8%), and the mean age was 7.04 ± 3.94 years.Recurrent fUTIs were detected in 65 patients (58%). Of the patients, 68 (60.7%) had abnormal urinary system USG, and 74 (66.1%)had abnormal DMSA renal scans. Vesicoureteral reflux (VUR) was detected in 63 patients (56.3%). VUR was present in 49 (66.2%) of74 patients with scarring in DMSA and detected in 14 (38.8%) of 38 patients with normal DMSA scans. Significant agreement (kappa:0.274 / p=0.003) was found between DMSA and VUR results. The sensitivity, specificity and positive predictive values of late DMSArenal scan to predict VUR were 77.8 %, 49 % and 63.2% respectively.Conclusion: Abnormal late DMSA scans carry a higher sensitivity and positive predictive value for predicting high-grade VUR inchildren with recurrent fUTIs. Late DMSA imaging seems a useful option in screening for high-grade VUR in children when the acuteinterventions are limited.
Anahtar Kelime: Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
- 1. Montini G, Tullus K, Hewitt I. Febrile Urinary Tract Infections in Children. N Engl J Med. 2011;365:239- 50.
- 2. Baumer JH, Jones RW. Urinary tract infection in children, National Institute for Health and Clinical Excellence. Arch Dis Child Educ Pract Ed 2007;92:189- 92
- 3. Paintsil E. Update on recent guidelines for the management of urinary tract infections in children: the shifting paradigm. Curr Opin Pediatr 2013;25:88- 94.
- 4. KoyleMA, Elder JS, Skoog SJ, et al. Febrile urinary tract infection, vesicoureteral reflux, and renal scarring: current controversies in approach to evaluation. Pediatr Surg Int 2011;27:337-46.
- 5. Lebowitz RL, Olbing H, Parkkulainen KV, et al. International system of radiographic grading of vesicoureteric reflux. International reflux study in children. Pediatr Radiol 1985;15:105-9.
- 6. Lee MD, Lin CC, Huang FY, et al. Screening young children with a first febrile urinary tract infection for high-grade vesicoureteral reflux with renal ultrasound scanning and technetium-99m-labeled dimercaptosuccinic acid scanning. J Pediatr 2009; 154:797-802.
- 7. Herz D, Merguerian P, McQuiston L, et al. 5-year prospective results of dimercapto-succinic acid imaging in children with febrile urinary tract infection: proof that the top-down approach works. J Urol 2010; 184:1703-9.
- 8. Park YS. Renal scar formation after urinary tract infection in children. Korean J Pediatr 2012;55:367- 70.
- 9. Pohl HG, Belman AB. The “top-down” approach to the evaluation of children with febrile urinary tract infection. Adv Urol 2009:783409.
- 10. Preda I, Jodal U, Sixt R, et al. Normal dimercaptosuccinic acid scintigraphy makes voiding cystourethrography unnecessary after urinary tract infection. J. Pediatr 2007;151:581-4.
- 11. Tekgül S, Riedmiller H, Hoebeke P, et al. European Association of Urology. EAU guidelines on vesicoureteral reflux in children. Eur Urol 2012; 62:534-42.
- 12. Hansson S, Dhamey M, Sigström O, et al. Dimercaptosuccinic acid scintigraphy instead of voiding cystourethrography for infants with urinary tract infection. J Urol 2004;172:1071-3.
- 13. Hoberman A, Charron M, Hickey RW, et al. Imaging studies after a first febrile urinary tract infectionin young children. N Engl J Med 2003;348:195-202.
- 14. Montini G, Zucchetta P, Tomasi L, et al. Value of imaging studies after a first febrile urinary tract infection in young children: datafrom Italian renal infection study. Pediatrics 2009;123:239-46.
- 15. Mahant S, Friedman J, Mac Arthur C. Renal ultrasound findings and vesicoureteral reflux in children hospitalized with urinary tract infection. Arch Dis Child 2002;86:419-20.
- 16. Shaikh N, Hoberman A, Rockette HE, et al. Identifying children with vesicoureteral reflux: a comparison of 2 approaches. J Urol. 2012;188:1895-9.
- 17. Wongbencharat K, Tongpenyai Y, Na-Rungsri K. Renal ultrasound and DMSA screening for high-grade vesicoureteral reflux. Pediatr Int 2016;58:214-8.
- 18. Riccabona M, Avni FE, Blickman JG, et al. Imaging recommendations in paediatric uroradiology: minutes of the ESPR workgroup session on urinarytract infection, fetal hydronephrosis, urinary tract ultrasonography and voiding cystourethrography, Barcelona, Spain, June2007. Pediatr Radiol 2008;38: 138-45.
- 19. Keren R. Imaging and treatment strategies for children after first urinary tract infection. Curr. Opin. Pediatr. 2007;19:705-10.
- 20. Tsai JD, Huang CT, Lin PY et al. Screening high-grade vesicoureteral reflux in young infants with a febrile urinary tract infection. Pediatr. Nephrol 2012;27:955- 63.
- 21. Lee HY, Soh BH, Hong CH, et al. The efficacy of ultrasound and dimercaptosuccinic acid scan in predicting vesicoureteral reflux in children below the age of 2 years with their first febrile urinary tract infection. Pediatr. Nephrol 2009;24:2009-13.
- 22. Lee MD, Lin CC, Huang FY, et al. Screening young children with a first febrile urinary tract infection for high-grade vesicoureteral reflux with renal ultrasound scanning and technetium-99m-labeled dimercaptosuccinic acid scanning.J. Pediatr 2009; 154:797-802.
- 23. Hansson S, Dhamey M, Sigström O, et al. Dimercaptosuccinic acid scintigraphy instead of voiding cystourethrography for infants with urinary tract infection. J Urol 2004;172:1071-3.
- 24. Tseng MH, Lin WJ, Lo WT, et al. Does a normal DMSA obviate the performance of voiding cystourethrography in evaluation of young children after their first urinary tract infection? J Pediatr 2007;150:96-9.
- 25. Shaikh N, Spingarn RB, HumSW. Dimercaptosuccinic acid scan or ultrasound in screening for vesicoureteral reflux among children with urinary tract infections. Cochrane Database Syst Rev. 2016;7:CD010657
- 26. Fouzas S, Krikelli E, Vassilakos P, et al. DMSA scan for revealing vesicoureteral reflux in young children with urinary tract infection. Pediatrics 2010;126:513-9.
- 27. Quirino IG, Silva JM, Diniz JS, et al. Combined use of late phase dimercapto-succinic acid renal scintigraphy and ultrasound as firstline screening after urinary tract infection in children. J Urol 2011;185:258-63.
- 28. Jakobsson B, Svensson L. Transient pyelonephritic changes on 99m Technetium-dimercaptosuccinic acid scan for at least five months after infection. Acta Paediatr 1997;86:803-7.
- 29. Snodgrass WT, Shah A, Yang M, et al. Prevalence and risk factors for renal scars in children with febrile UTI and/or VUR: a cross-sectional observational study of 565 consecutive patients. J Pediatr Urol 2013;9:856- 63.
- 30. Ascenti G, Zimbaro G, Mazziotti S, et al. Vesicoureteral reflux: comparison between urosonography and radionuclide cystography. Pediatr Nephrol 2003;18: 768-71.
| APA | Nalcacioglu H, çağlar ö, Yel S, celik b, Baştuğ F (2020). Clinical value of late DMSA scan in predicting vesicoureteral reflux in children with febrile urinary tract infection. , 733 - 737. 10.5455/annalsmedres.2020.01.033 |
| Chicago | Nalcacioglu Hulya,çağlar özgür,Yel Sibel,celik binnaz,Baştuğ Funda Clinical value of late DMSA scan in predicting vesicoureteral reflux in children with febrile urinary tract infection. (2020): 733 - 737. 10.5455/annalsmedres.2020.01.033 |
| MLA | Nalcacioglu Hulya,çağlar özgür,Yel Sibel,celik binnaz,Baştuğ Funda Clinical value of late DMSA scan in predicting vesicoureteral reflux in children with febrile urinary tract infection. , 2020, ss.733 - 737. 10.5455/annalsmedres.2020.01.033 |
| AMA | Nalcacioglu H,çağlar ö,Yel S,celik b,Baştuğ F Clinical value of late DMSA scan in predicting vesicoureteral reflux in children with febrile urinary tract infection. . 2020; 733 - 737. 10.5455/annalsmedres.2020.01.033 |
| Vancouver | Nalcacioglu H,çağlar ö,Yel S,celik b,Baştuğ F Clinical value of late DMSA scan in predicting vesicoureteral reflux in children with febrile urinary tract infection. . 2020; 733 - 737. 10.5455/annalsmedres.2020.01.033 |
| IEEE | Nalcacioglu H,çağlar ö,Yel S,celik b,Baştuğ F "Clinical value of late DMSA scan in predicting vesicoureteral reflux in children with febrile urinary tract infection." , ss.733 - 737, 2020. 10.5455/annalsmedres.2020.01.033 |
| ISNAD | Nalcacioglu, Hulya vd. "Clinical value of late DMSA scan in predicting vesicoureteral reflux in children with febrile urinary tract infection". (2020), 733-737. https://doi.org/10.5455/annalsmedres.2020.01.033 |
| APA | Nalcacioglu H, çağlar ö, Yel S, celik b, Baştuğ F (2020). Clinical value of late DMSA scan in predicting vesicoureteral reflux in children with febrile urinary tract infection. Annals of Medical Research, 27(3), 733 - 737. 10.5455/annalsmedres.2020.01.033 |
| Chicago | Nalcacioglu Hulya,çağlar özgür,Yel Sibel,celik binnaz,Baştuğ Funda Clinical value of late DMSA scan in predicting vesicoureteral reflux in children with febrile urinary tract infection. Annals of Medical Research 27, no.3 (2020): 733 - 737. 10.5455/annalsmedres.2020.01.033 |
| MLA | Nalcacioglu Hulya,çağlar özgür,Yel Sibel,celik binnaz,Baştuğ Funda Clinical value of late DMSA scan in predicting vesicoureteral reflux in children with febrile urinary tract infection. Annals of Medical Research, vol.27, no.3, 2020, ss.733 - 737. 10.5455/annalsmedres.2020.01.033 |
| AMA | Nalcacioglu H,çağlar ö,Yel S,celik b,Baştuğ F Clinical value of late DMSA scan in predicting vesicoureteral reflux in children with febrile urinary tract infection. Annals of Medical Research. 2020; 27(3): 733 - 737. 10.5455/annalsmedres.2020.01.033 |
| Vancouver | Nalcacioglu H,çağlar ö,Yel S,celik b,Baştuğ F Clinical value of late DMSA scan in predicting vesicoureteral reflux in children with febrile urinary tract infection. Annals of Medical Research. 2020; 27(3): 733 - 737. 10.5455/annalsmedres.2020.01.033 |
| IEEE | Nalcacioglu H,çağlar ö,Yel S,celik b,Baştuğ F "Clinical value of late DMSA scan in predicting vesicoureteral reflux in children with febrile urinary tract infection." Annals of Medical Research, 27, ss.733 - 737, 2020. 10.5455/annalsmedres.2020.01.033 |
| ISNAD | Nalcacioglu, Hulya vd. "Clinical value of late DMSA scan in predicting vesicoureteral reflux in children with febrile urinary tract infection". Annals of Medical Research 27/3 (2020), 733-737. https://doi.org/10.5455/annalsmedres.2020.01.033 |
