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The Indian Journal of Pediatrics

, Volume 86, Issue 9, pp 784–789 | Cite as

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

  • Alejandro BalestracciEmail author
  • Micaela Montecuco
  • Carla Serviddio
  • Lourdes Domínguez Figueredo
  • Virginia Montiel
  • Cecilia Torres Perez
  • Iris Puyol
  • Marina A. Capone
Original Article

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.

Keywords

Urinary tract infection Older children Diagnostic imaging Top-down approach Late dimercaptosuccinic acid scan Vesicoureteral reflux 

Notes

Authors’ 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.

Compliance with Ethical Standards

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).

Conflict of Interest

None.

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Copyright information

© Dr. K C Chaudhuri Foundation 2019

Authors and Affiliations

  • Alejandro Balestracci
    • 1
    Email author
  • Micaela Montecuco
    • 2
  • Carla Serviddio
    • 2
  • Lourdes Domínguez Figueredo
    • 2
  • Virginia Montiel
    • 2
  • Cecilia Torres Perez
    • 2
  • Iris Puyol
    • 1
  • Marina A. Capone
    • 1
  1. 1.Nephrology UnitHospital General de Niños Pedro de ElizaldeCiudad Autónoma de Buenos AiresArgentina
  2. 2.Department of PediatricsHospital General de Niños Pedro de ElizaldeCiudad Autónoma de Buenos AiresArgentina

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