The role of DMSA scans in evaluation of the correlation between urinary tract infection, vesicoureteric reflux, and renal scarring

2002 ◽  
Vol 18 (2-3) ◽  
pp. 128-134 ◽  
Author(s):  
V. Bhatnagar ◽  
D. K. Mitra ◽  
S. Agarwala ◽  
R. Kumar ◽  
C. Patel ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Renal Scarring ◽  
Vesicoureteric Reflux

scholarly journals Association of Vesicoureteric Reflux (VUR) in Children with Symptomatic Urinary Tract Infection (UTI) - in a Tertiary Care Hospital, Dhaka, Bangladesh

2013 ◽  
Vol 37 (2) ◽  
pp. 79-84
Author(s):  
Afroza Begum ◽  
Habibur Rahman ◽  
MM Hossain ◽  
Golam Muinuddin ◽  
Ranjit Ranjan Roy ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Renal Scarring ◽  
Tertiary Care ◽  
Vesicoureteric Reflux ◽  
Pediatric Nephrology ◽  
Care Hospital ◽  
Age Group ◽  
Micturating Cystourethrogram

Background: Vesicoureteric reflux is the most common urinary tract anomaly affecting the children which predisposes to higher rates of urinary tract infection and renal scarring than those without VUR. Objective: To find out the associations of VUR in children presented with UTI. Methodology: This cross sectional study was conducted in 36 children aged 1 month to 16 years who were admitted due to UTI in the Pediatric Nephrology Department of Bangabandhu Sheikh Mujib Medical University (BSMMU) from July 2009 to June 2010. UTI were evaluated by urinalysis, culture and sensitivity test, ultrasonography of the urinary system with post-voidal residue and micturating cystourethrogram subsequently. Results: This study revealed that UTI were most frequent in boys (P<0.001). Maximum number 19(52.7%) of UTI cases were detected between 12 months -60 months age group of children. Highest number of bilateral hydronephrosis 7(71.43%) and VUR 12(63.15%) were also detected in the were detected in 2-23 months age group of children. Maximum number of 22/38 kidneys (57.90%) with refluxing units were detected between 12 months to 60 months (1-5 years) age group and out of this 16(72.72%) units are of severe grades. Conclusion: Children presented with UTI along with features of obstructive- uropathy must be investigated early and carefully for VUR to prevent recurrent UTI and renal damage. DOI: http://dx.doi.org/10.3329/bjch.v37i2.17264 BANGLADESH J CHILD HEALTH 2013; VOL 37 (2) : 79-84

Urinary tract infection in infancy and childhood

2018 ◽  
Author(s):  
Heather Lambert
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Acute Pyelonephritis ◽  
Renal Scarring ◽  
Vesicoureteric Reflux ◽  
Adult Life ◽  
Urinary Tract Abnormality ◽  
Increased Risk

Urinary tract infection (UTI) in childhood is a common problem, which is frequently dismissed as trivial because most children with UTI have a good outcome. However, UTI is an important cause of acute illness in children and causes a considerable burden of ill health on children and families. In addition, UTI may be a marker of an underlying urinary tract abnormality. UTI in a few may cause significant long-term morbidity, renal scarring, hypertension, and renal impairment that may not present until adult life. Predicting which children will go on to have long-term sequelae remains a challenge.The risk of renal scarring is greatest in infants, the very group in whom diagnosis is often overlooked or delayed because clinical features are non-specific. Delay in treatment is associated with an increased risk of scarring in susceptible children. Thus accurate and rapid diagnosis of UTI is essential and requires a very high index of suspicion particularly in the youngest.The role of vesicoureteric reflux in acquired scarring is not fully understood though there is clearly an association, possibly because it is a risk factor for acute pyelonephritis. Scarring when it occurs is in the areas affected by acute pyelonephritis. Higher grades of reflux are associated with a worse outcome.Management and investigation of children with UTI consumes considerable healthcare resources. Limited understanding of the natural history and basic pathophysiology, variations in strategy with time and setting, and lack of evidence on long-term outcomes have resulted in considerable uncertainty. Some propose a minimal approach doing little investigation unless there is clear evidence for it; others favour an approach of continuation of current practice based on clinical experience until further evidence evolves. Some of the themes behind these controversies are explored.

Renal Power Doppler Ultrasound Does Not Predict Renal Scarring after Urinary Tract Infection

2008 ◽  
Vol 53 (4) ◽  
pp. 7-10 ◽  
Author(s):  
H Narchi ◽  
R Donovan
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Predictive Value ◽  
Renal Scarring ◽  
Power Doppler ◽  
Power Doppler Ultrasound ◽  
Predictive Values ◽  
Dmsa Scan

Objective Young children may develop renal scarring following a urinary tract infection (UTI) especially after pyelonephritis which is difficult to diagnose. Permanent renal scars are diagnosed by dimercapto-succinic acid (DMSA) scan several months later. To decrease unnecessary exposure to radiation, we investigate the role of renal power Doppler (RPD) in predicting those who may not require a late DMSA scan. Methods Children under four years of age with a first UTI underwent an RPD study soon after diagnosis, and a DMSA scintigraphy six months later. The predictive values of the early RPD to detect DMSA renal scarring were calculated. Results Twenty three children (median age 30 months) were enrolled: 13 had a febrile presentation, two with bacteraemia. Permanent scarring occurred in three children (13%). In the 46 kidney units studied, initial RPD was abnormal in two and late DMSA abnormal in three units. Overall concordance between RPD and DMSA was 93.5%. The sensitivity of RPD for renal scar as per DMSA was 33.3%, specificity 97.7%; positive predictive value 50% and a negative predictive value of 95.4%. Conclusions RPD offered no advantage over ultrasound to predict renal scarring and cannot be recommended to predict renal scarring following UTI.

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