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Identifying children with vesicoureteral reflux: a comparison of 2 approaches
Nader Shaikh1, Alejandro Hoberman, Howard E Rockette
1Division of General Academic Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15224, USA.
Insights
The top-down renal scan and C-reactive protein tests are not sensitive enough for identifying high-grade vesicoureteral reflux in children with urinary tract infections. Further research is needed for better screening methods to prevent kidney scarring.
Area of Science:
- Pediatric Nephrology
- Diagnostic Imaging
- Biomarker Discovery
Background:
- Urinary tract infections (UTIs) are common in children.
- Vesicoureteral reflux (VUR) is a significant risk factor for renal scarring.
- Accurate screening for VUR is crucial to prevent long-term kidney damage.
Purpose of the Study:
- To compare the sensitivity of two common screening approaches for identifying VUR in children.
- To evaluate the effectiveness of the top-down (renal scan) and biomarker-based (C-reactive protein) methods in detecting high-grade VUR.
Main Methods:
- Retrospective analysis of screening data in children with UTIs.
- Calculation of sensitivity for detecting VUR and high-grade VUR (grade III or greater).
- Comparison of the top-down approach using (99m)technetium dimercaptosuccinic acid renal scan versus biomarker-based C-reactive protein levels.
Main Results:
- The top-down approach missed 33% of high-grade VUR cases.
- The C-reactive protein based approach missed 29% of high-grade VUR cases.
- Both screening methods demonstrated suboptimal sensitivity for high-grade VUR.
Conclusions:
- The sensitivity of the top-down approach for high-grade VUR is lower than previously reported.
- Current screening methods may not adequately identify children at risk for renal scarring.
- Novel diagnostic strategies are needed to improve the detection of VUR in pediatric UTIs.
Purpose:
Various screening approaches have been proposed to identify the subgroup of children with urinary tract infection who have vesicoureteral reflux. However, few studies have compared the sensitivity of screening approaches in a representative population of young children. We compared the sensitivities of the top-down ((99m)technetium dimercaptosuccinic acid renal scan to screen) and biomarker based (C-reactive protein level at presentation) approaches in identifying children with vesicoureteral reflux.
Materials And Methods:
We calculated the sensitivity of the 2 screening approaches in detecting vesicoureteral reflux and subsequently high grade (III or greater) vesicoureteral reflux in children.
Results:
The top-down and C-reactive protein based approaches missed 33% and 29% of cases of high grade vesicoureteral reflux, respectively.
Conclusions:
The sensitivity of the top-down approach for detecting high grade vesicoureteral reflux was lower than previously reported. Further study of novel methods to identify children at risk for renal scarring is warranted.
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