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Power Doppler ultrasonography in the diagnosis of acute childhood pyelonephritis

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Abstract

In the absence of specific symptomatology in children, the early diagnosis of acute pyelonephritis (APN) is a challenge, particularly during infancy. In an attempt to differentiate APN from lower urinary tract infection (UTI), we evaluated the ability of power Doppler ultrasonography (PDU) to predict renal parenchymal involvement, as assessed by dimercaptosuccinic acid (99m Tc-DMSA) scintigraphy. The study comprised 62 patients, 46 girls and 16 boys, aged 2 weeks to 5 years, admitted to the pediatric department with febrile UTI. All children were examined by PDU and DMSA scintigraphy within the first 3 days of admission. In the group of 31 patients with one or more DMSA scan abnormalities, the PDU showed a matching perfusion defect in 27 (87%). Of 26 children with normal DMSA scintigraphy, the PDU evaluation was also normal in 24. The sensitivity and specificity of PDU for the detection of affected kidneys were 87% and 92.3%, and the positive predictive value and negative predictive value were 93.1% and 85.7%, respectively. These data indicate the PDU has a high sensitivity and specificity for differentiating APN from lower UTI and may be a useful and practical tool for the diagnosis of APN in infants and children.

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Authors and Affiliations

  1. Pediatric Department B, Ha’Emek Medical Center, 18101, Afula, Israel

    Raphael Halevy, Vladislav Smolkin, Waheeb Sakran & Ariel Koren

  2. Pediatric Nephrology Unit, Ha’Emek Medical Center, Afula, Israel

    Raphael Halevy & Vladislav Smolkin

  3. Department of Nuclear Medicine, Ha’Emek Medical Center, Afula, Israel

    Sergey Bykov

  4. Department of Radiology, Ha’Emek Medical Center, Afula, Israel

    Leonid Chervinsky

  5. Baruch Rappaport School of Medicine, Technion, Israel Institute of Technology, Haifa, Israel

    Waheeb Sakran & Ariel Koren

Authors
  1. Raphael Halevy
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  2. Vladislav Smolkin
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  3. Sergey Bykov
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  4. Leonid Chervinsky
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  5. Waheeb Sakran
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  6. Ariel Koren
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Correspondence to Vladislav Smolkin.

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Halevy, R., Smolkin, V., Bykov, S. et al. Power Doppler ultrasonography in the diagnosis of acute childhood pyelonephritis. Pediatr Nephrol 19, 987–991 (2004). https://doi.org/10.1007/s00467-004-1529-6

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  • DOI: https://doi.org/10.1007/s00467-004-1529-6

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