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Screening high-grade vesicoureteral reflux in young infants with a febrile urinary tract infection

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Abstract

Background

The lack of good evidence for improved outcomes in children and young infants with febrile urinary tract infection (UTI) after aggressive treatment for vesicoureteral reflux (VUR) has raised doubts regarding the need for routine voiding cystourethrography (VCUG), and the appropriate imaging evaluation in these children remains controversial.

Objectives

This prospective study aimed to determine whether abnormalities found on acute dimercaptosuccinic acid (DMSA) scan and ultrasound (US) can help indicate the necessity of voiding cystourethrography (VCUG) in young infants.

Methods

For 3.5 years, all infants younger than 3 months presenting with first febrile UTI were prospectively studied. All infants were hospitalized and investigated using US (<3 days after admission), DMSA scan (<5 days after admission), and VCUG (7–10 days after antibiotic treatment) after diagnosis. The association among findings of US, DMSA scan, and VCUG were evaluated.

Results

From 220 infants, there were abnormal results in 136 (61.8%) US and in 111 (50.5%) DMSA scans. By US, ten infants (4.5%) with abscess or structural abnormalities other than VUR were diagnosed. High-grade (III–V) VUR was present in 39 patients (17.7%). The sensitivities for high-grade VUR of renal US alone (76.9%) or DMSA scan alone (82.1%) were not as good as that of the “OR rule” strategy, which had 92.3% sensitivity and 94.3% negative predictive value.

Conclusions

To screen high-grade VUR in young infants with febrile UTI, US and acute DMSA scan could be performed first. VCUG is only indicated when abnormalities are apparent on either US or DMSA scan or both.

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Conflict of interest

None of the authors have any conflict of interest related to the investigation.

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Authors and Affiliations

  1. Department of Pediatrics, Mackay Memorial Hospital, No 92, Section 2, Chungshan North Road, Taipei, Taiwan

    Jeng-Daw Tsai, Chang-Ting Huang, Jui-Hsing Chang, Ming-Dar Lee, Fu-Yuan Huang, Han-Yang Hung, Chyong-Hsin Hsu, Hsin-An Kao & Chun-Chen Lin

  2. Department of Pediatrics, Taipei Medical University, Taipei, Taiwan

    Jeng-Daw Tsai & Fu-Yuan Huang

  3. Department of Pediatrics, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan

    Pei-Yi Lin

  4. Mackay Medicine, Nursing and Management College, Taipei, Taiwan

    Jui-Hsing Chang & Chun-Chen Lin

  5. Division of Nuclear Medicine, Mackay Memorial Hospital, Taipei, Taiwan

    Bing-Fu Shih

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  1. Jeng-Daw Tsai
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  11. Chun-Chen Lin
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Correspondence to Chun-Chen Lin.

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Tsai, JD., Huang, CT., Lin, PY. et al. Screening high-grade vesicoureteral reflux in young infants with a febrile urinary tract infection. Pediatr Nephrol 27, 955–963 (2012). https://doi.org/10.1007/s00467-012-2104-1

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  • DOI: https://doi.org/10.1007/s00467-012-2104-1

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