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Role of Late DMSA Renal Scan in Detecting High-Grade Vesicoureteral Reflux

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Abstract

Objective

To determine the performance of late dimercaptosuccinic acid (DMSA) renal scans in identifying high-grade (III-V) vesicoureteral reflux (VUR) in children aged over 3 y with a febrile urinary tract infection (fUTI) history that has not been timely investigated.

Methods

In this retrospective study of diagnostic accuracy, the clinical records of children aged between 3 and 18 y with fUTI history evaluated consecutively at Nephrology Unit of Hospital General de Niños Pedro de Elizalde, Argentina between 2006 and 2016 were reviewed. Patients with previously diagnosed renal or urinary tract abnormalities or who underwent previous postnatal genitourinary imaging were excluded. Only those assessed by renal and bladder ultrasound (RBUS), voiding cystourethrogram (VCUG) and late 6-mo DMSA scan were analyzed. The ability of the scintigraphy in identifying high-grade VUR was determined by comparing its findings with those of VCUG.

Results

In 122 children (median age 5.37 y, 88.5% girls) RBUS was abnormal in 53 (43.4%) and 58 (47.5%) had VUR (30 of high-grade). Abnormal DMSA scan findings (70 patients, 57.4%) were associated with all grade (p = 0.00001) and with high-grade VUR (p = 0.00001). Sensitivity, specificity, negative (NPV) and positive (PPV) predictive values of late DMSA scans for all grades VUR were 93.1%, 75%, 92.3% and 77.1%, respectively. Only 4 patients with low-grade VUR had normal scans. For high-grade VUR, sensitivity and NPV reached 100%.

Conclusions

In older children, the normal late DMSA scan predicted the absence of high-grade VUR, obviating the need for a VCUG. This approach could be a possible strategy for children not studied at acute infection time.

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Authors and Affiliations

  1. Nephrology Unit, Hospital General de Niños Pedro de Elizalde, Montes de Oca 40, CP 1270, Ciudad Autónoma de Buenos Aires, Argentina

    Alejandro Balestracci, Iris Puyol & Marina A. Capone

  2. Department of Pediatrics, Hospital General de Niños Pedro de Elizalde, Montes de Oca 40, Ciudad Autónoma de Buenos Aires, Argentina

    Micaela Montecuco, Carla Serviddio, Lourdes Domínguez Figueredo, Virginia Montiel & Cecilia Torres Perez

Authors
  1. Alejandro Balestracci
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  2. Micaela Montecuco
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  3. Carla Serviddio
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  4. Lourdes Domínguez Figueredo
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  5. Virginia Montiel
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  6. Cecilia Torres Perez
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  7. Iris Puyol
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  8. Marina A. Capone
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Contributions

AB planned the study and wrote the initial draft of this paper; all authors were involved in gathering data, paper revision, analysis, and final approval of this paper. AB is the guarantor for this article.

Corresponding author

Correspondence to Alejandro Balestracci.

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Ethical Approval

This clinical research was approved by the Institutional Review Board and Ethics Committee of the Hospital General de Niños Pedro de Elizalde (IRB: 404/16).

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Balestracci, A., Montecuco, M., Serviddio, C. et al. Role of Late DMSA Renal Scan in Detecting High-Grade Vesicoureteral Reflux. Indian J Pediatr 86, 784–789 (2019). https://doi.org/10.1007/s12098-019-02917-4

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  • DOI: https://doi.org/10.1007/s12098-019-02917-4

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