Role of Late DMSA Renal Scan in Detecting High-Grade Vesicoureteral Reflux
- 62 Downloads
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.
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.
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%.
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.
KeywordsUrinary tract infection Older children Diagnostic imaging Top-down approach Late dimercaptosuccinic acid scan Vesicoureteral reflux
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.
Compliance with Ethical Standards
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).
Conflict of Interest
- 2.Lee MD, Lin CC, Huang FY, Tsai TC, Huang CT, Tsai JD. 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. J Pediatr. 2009;154:797–802.CrossRefGoogle Scholar
- 5.Pohl HG, Belman AB. The "top-down" approach to the evaluation of children with febrile urinary tract infection. Adv Urol. 2009;783409.Google Scholar
- 8.Indian Society of Pediatric Nephrology, Vijayakumar M, Kanitkar M, Nammalwar BR, Bagga A. Revised statement on management of urinary tract infections. Indian Pediatr. 2011;48:709–17.Google Scholar
- 9.Comité de Nefrología. New recommendations against the current controversies in urinary tract infection: executive summary. Arch Argent Pediatr. 2015;113:579–81.Google Scholar
- 28.Shaikh N, Spingarn RB, Hum SW. Dimercaptosuccinic acid scan or ultrasound in screening for vesicoureteral reflux among children with urinary tract infections. Cochrane Database Syst Rev. 2016;7:CD010657.Google Scholar