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

Lee, Ming-Dar; Lin, Chun-Chen; Huang, Fu-Yuan; Tsai, Tsuen-Chiuan; Huang, Chang-Ting; Tsai, Jeng-Daw

doi:10.1016/j.jpeds.2008.12.045

« Previous Next »The Journal of Pediatrics
Volume 154, Issue 6 , Pages 797-802, June 2009

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

Ming-Dar Lee, MD
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
Chun-Chen Lin, MD
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
- Mackay Medicine, Nursing and Management College, Taipei, Taiwan
Fu-Yuan Huang, MD
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Pediatrics, Taipei Medical University, Taipei, Taiwan
Tsuen-Chiuan Tsai, MD
- Department of Pediatrics, Taipei Medical University Municipal Wan Fang Hospital, Taipei, Taiwan
Chang-Ting Huang, MD
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
Jeng-Daw Tsai, MD
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
- Mackay Medicine, Nursing and Management College, Taipei, Taiwan
- Department of Pediatrics, Taipei Medical University, Taipei, Taiwan
- Reprint requests: Jeng-Daw Tsai, Department of Pediatrics, Mackay Memorial Hospital, No 92, Section 2, Chungshan North Rd, Taipei, Taiwan

Received 30 May 2008; received in revised form 4 November 2008; accepted 29 December 2008. published online 23 February 2009.

Objective

To evaluate the predictive value of renal ultrasound scanning and 99m-Technetium-dimercaptosuccinic acid (DMSA) scintigraphy for high-grade vesicoureteral reflux (VUR) in young children with a first urinary tract infection (UTI).

Study design

The medical records of children who had been examined with renal ultrasound scanning, DMSA scanning, and voiding cystourethrography (VCUG) were reviewed. The findings of renal ultrasound scanning, DMSA scanning, and their predictive values were evaluated.

Results

Of 699 children, high-grade VUR (grades III-V) was diagnosed in 119 (17.0%). Signs of renal hypodysplasia (OR, 16.15), cyclic dilatation of pelvicaliceal system (OR, 11.73), hydroureter (OR, 4.00) with renal ultrasound scanning, and renal hypodysplasia (OR, 8.78), acute pyelonephritis (OR, 2.76) with DMSA scanning were associated with high-grade VUR. The sensitivities for high-grade VUR of ultrasound scanning alone (67.2%) or DMSA scanning alone (65.5%) were not as good as that of a both-test strategy, which had a sensitivity rate of 83.2%. The negative predictive value of the both-test strategy was 91.5%.

Conclusion

Renal ultrasound scanning and DMSA scanning both should be routinely performed in children with a first febrile UTI. VCUG is only indicated when abnormalities are apparent on either ultrasound scanning or DMSA scanning or both.

Abbreviations: APN, Acute pyelonephritis, DMSA, Technetium-99m-labeled dimercaptosuccinic acid, OR, Odds ratio, UTI, Urinary tract infection, VCUG, Voiding cystourethrography, VUR, Vesicoureteral reflux