Evaluation of imaging studies for vesicoureteral reflux in infants with first urinary tract infection

Area of Science:

• Pediatric Nephrology
• Diagnostic Imaging
• Urology

Background:

• Routine imaging, including renal ultrasound, voiding cystourethrography (VCUG), and dimercaptosuccinic acid (DMSA) scans, is standard after a first urinary tract infection (UTI) in infants to detect vesicoureteral reflux (VUR) and renal scarring.
• The clinical benefit and justification for these routine investigations in preventing renal complications remain unclear.

Purpose of the Study:

• To evaluate the effectiveness of routine imaging investigations, specifically VCUG, in infants following their first documented UTI.
• To determine the correlation between VUR detected by VCUG and renal scarring identified by DMSA scans.

Main Methods:

• A cohort of 114 infants with a first UTI underwent initial renal ultrasound, VCUG, and DMSA scan.
• Follow-up VCUG and/or DMSA scans were performed after 4-6 months for abnormal initial findings.
• Statistical analysis correlated VUR on VCUG with acute and follow-up DMSA findings of renal scarring.

Main Results:

• Vesicoureteral reflux (VUR) was detected in 14.9% of infants via VCUG.
• Abnormal findings on acute DMSA scans (suggesting pyelonephritis or scarring) were present in 40.4% of patients.
• The correlation between initial VUR detection and subsequent renal scarring on follow-up DMSA scans was low. DMSA demonstrated a negative predictive value of 94.3% for VUR.

Conclusions:

• Routine VCUG investigation following a first UTI in infants shows limited effectiveness.
• VCUG may be considered unnecessary for infants under one year with a first UTI if initial DMSA scans are normal.
• This approach could help avoid unnecessary procedures and associated costs.