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[Imaging studies in the first urinary infection with fever in infants: is voiding cystourethrography necessary?]
O Muga Zuriarrain1, E Oñate Vergara, I Sota Busselo
1Servicio de Pediatría, Hospital Donostia, San Sebastián, Guipúzcoa, España.
Insights
In infants with a first-time urinary tract infection (UTI), a negative DMSA scan effectively rules out severe vesicoureteral reflux (VUR), making voiding cystourethrography (VCUG) unnecessary.
Area of Science:
- Pediatric Nephrology
- Diagnostic Imaging
- Urology
Background:
- Vesicoureteral reflux (VUR) in infants with urinary tract infection (UTI) does not always lead to renal injury; only severe reflux is a significant factor.
- Early detection of severe VUR is crucial for preventing acquired renal injury in infants.
Purpose of the Study:
- To evaluate the utility of dimercaptosuccinic acid (DMSA) scans as a screening tool for severe VUR in infants with a first-time febrile UTI.
- To determine if DMSA can replace voiding cystourethrography (VCUG) in this patient population.
Main Methods:
- Retrospective study of 162 infants under 2 years old with a first-time febrile UTI.
- All infants underwent renal ultrasound, DMSA scan, and VCUG shortly after diagnosis.
Main Results:
- 62 infants (38%) had VUR, with 6% being severe.
- DMSA scans correctly identified all 6 cases of severe VUR (100% sensitivity).
- A negative DMSA scan had a 100% negative predictive value for severe VUR.
Conclusions:
- VCUG is unnecessary for infants with a first-time UTI and a negative DMSA scan.
- DMSA scans are effective in screening for severe VUR, potentially reducing the need for VCUG.
Introduction:
The presence of vesicoureteral reflux (VUR) in an infant with urinary tract infection (UTI), does not necessarily lead to an acquired renal injury. Only serious reflux can be a factor in fostering its appearance.
Objectives:
To assess whether in infants diagnosed for the first time with a UTI with a fever, a routine initial DMSA can be used as a screening method for detecting severe reflux and replace voiding cystourethrography (VCUG).
Patients And Methods:
We retrospectively studied 162 infants under 2 years old admitted to our hospital due to having a ITU with fever for the first time (92 males and 70 females). In all cases, a renal ultrasound, DMSA and VCUG had been performed a few days after the diagnosis.
Results:
Of the 162 patients, 62 (38 %) had VUR, of which 56 (90 %) were mild and 6 (10 %) were severe. The DMSA was abnormal in 26/100 patients without VUR (26 %), 12/56 with mild VUR (21 %) and 6/6 of those with severe VUR (100 %). DMSA sensitivity for detecting severe reflux was 100 % and specificity was 76 %. The positive predictive value and negative predictive value was 14 % and 100 % respectively. The positive likelihood ratio was 4.17 and the negative likelihood ratio was 0.
Conclusions:
It is unnecessary to carry out VCUG in an infant with an initial UTI, and a negative DMSA.
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