Renal damage detected by DMSA, despite normal renal ultrasound, in children with febrile UTI

N. C. Bush, M. Keays, C. Adams, K. Mizener, K. Pritzker, W. Smith, J. Traylor, C. Villanueva, W. T. Snodgrass

Research output: Contribution to journalArticle

25 Scopus citations

Abstract

Objectives 2011 American Academy of Pediatrics guidelines recommended renal-bladder ultrasound (RBUS) as the only evaluation after febrile urinary tract infection (FUTI) in infants aged 2-24 months. We determined the sensitivity, specificity, and false negative rate of RBUS to identify DMSA-detected renal damage in this age group as well as in older children. Methods Consecutive patients referred to pediatric urology with a history of FUTI underwent DMSA 3 months after FUTI. Abnormal RBUS was defined as: Society of Fetal Urology hydronephrosis grades I-IV; hydroureter 7 mm; renal scar defined as focal parenchymal thinning; and/or size discrepancy 1 cm between kidneys. Abnormal DMSA was presence of any focal uptake defects and/or split renal function <44%. We calculated sensitivity, specificity, positive and negative predictive values, and false negative rates of RBUS compared to DMSA. Results 618 patients (79% female), median age 3.4 years, were referred for FUTIs. Of the 512 (83%) with normal RBUS, 99 (19%) had abnormal DMSA. Children with normal RBUS after their first FUTI had abnormal DMSA in 15/151 (10%) aged â‰24 months and 23/119 (19%) aged ;gt&24 months. RBUS had poor sensitivity (34%) and low positive predictive value (47%) to identify patients with renal damage. 99/149 (66%) children with renal damage on DMSA had normal RBUS. Conclusion After FUTI, 66% of children with reduced renal function and/or renal cortical defects found by DMSA scintigraphy had a normal RBUS. Since abnormal DMSA may correlate with increased risk for VUR, recurrent FUTI and renal damage, our data suggest RBUS alone will fail to detect a significant proportion of patients at risk. The data suggest that imaging after FUTI should include acute RBUS and delayed DMSA, reserving VCUG for patients with abnormal DMSA and/or recurrent FUTI.

Original languageEnglish (US)
Pages (from-to)126.e1-126.e7
JournalJournal of Pediatric Urology
Volume11
Issue number3
DOIs
StatePublished - Jun 1 2015

Keywords

  • DMSA
  • Renal ultrasonography
  • UTI
  • VUR

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Urology

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    Bush, N. C., Keays, M., Adams, C., Mizener, K., Pritzker, K., Smith, W., Traylor, J., Villanueva, C., & Snodgrass, W. T. (2015). Renal damage detected by DMSA, despite normal renal ultrasound, in children with febrile UTI. Journal of Pediatric Urology, 11(3), 126.e1-126.e7. https://doi.org/10.1016/j.jpurol.2015.01.011