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Kidney imaging in management of delayed febrile urinary tract infection

Sayed Abolhassan Sayedzadeh1, Majid Malaki, Maryam Shoaran

  • 1Department of Pediatric Nephrology, Tabriz Medical University, Tabriz, Iran.

Saudi Journal of Kidney Diseases and Transplantation : an Official Publication of the Saudi Center for Organ Transplantation, Saudi Arabia
|November 18, 2011
PubMed

Insights

Delayed diagnosis of pediatric urinary tract infections (UTIs) leads to kidney damage. A Tc99-Dimercaptosuccinic acid (DMSA) scan can identify pyelonephritis, while cystography is crucial for diagnosing vesicoureteral reflux (VUR).

Area of Science:

  • Pediatric Nephrology
  • Diagnostic Imaging
  • Infectious Diseases

Background:

  • Urinary tract infections (UTIs) are common in children, often presenting with prolonged fever.
  • Febrile UTIs can lead to renal scarring (pyelonephritis) and vesicoureteral reflux (VUR).
  • Early diagnosis and treatment are crucial to prevent long-term kidney damage.

Purpose of the Study:

  • To evaluate imaging findings in children with protracted fever due to UTI.
  • To assess the utility of Tc99-Dimercaptosuccinic acid (DMSA) scans and kidney sonography.
  • To determine the relationship between VUR, DMSA scan findings, and delayed diagnosis.

Main Methods:

  • Cross-sectional study of 40 children (1 month to 5 years) with fever >48 hours due to UTI.
  • Utilized Tc99-Dimercaptosuccinic acid (DMSA) scans and kidney sonography for imaging.
  • Analyzed data for correlations between age, sex, VUR, DMSA findings, and diagnosis/treatment delays.

Main Results:

  • 85% of patients had positive DMSA scans, indicating pyelonephritis.
  • 58% of patients had confirmed vesicoureteral reflux (VUR).
  • Delayed diagnosis of febrile UTI correlated with abnormal DMSA scans, regardless of age, sex, or VUR presence. Mild VUR might show normal DMSA, while moderate/severe VUR almost always showed abnormal DMSA findings.

Conclusions:

  • Delayed diagnosis and treatment of febrile UTIs are associated with a high incidence of pyelonephritis on DMSA scans.
  • A normal DMSA scan can help rule out moderate to severe VUR.
  • Cystography remains the gold standard for diagnosing VUR.

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