Related Experiment Video
Updated: Mar 22, 2026
Rapid Antimicrobial Susceptibility Testing by Stimulated Raman Scattering Imaging of Deuterium Incorporation in a Single Bacterium
Published on: February 14, 2022
A Clinical Scoring System for Prediction of an Abnormal DMSA in Paediatric Patients After the First Episode of
Sanjna Nilesh Nerurkar1, Yong Hong Ng2, Celeste Jia Ying Yap2
1Paediatric Medicine, KK Women's and Children's Hospital, Singapore, Singapore.
Insights
A clinical risk prediction model using serum creatinine, procalcitonin, and C-reactive protein (CRP) can identify children with febrile urinary tract infection (UTI) at risk for kidney scarring. This helps target early interventions for better outcomes in pediatric patients.
Area of Science:
- Pediatric Nephrology
- Diagnostic Imaging
- Clinical Risk Prediction
Background:
- Children with febrile urinary tract infection (UTI) face increased risk of kidney scarring.
- Late dimercaptosuccinic acid (DMSA) scans, performed ≥3 months post-UTI, identify scarring.
- Early identification of at-risk children is crucial for timely intervention.
Purpose of the Study:
- Develop a clinical risk prediction model for abnormal late DMSA scans after a first febrile UTI.
- Identify key clinical and laboratory markers associated with kidney scarring.
- Improve early detection of potential renal damage in pediatric UTI cases.
Main Methods:
- Retrospective cohort study of children with their first febrile UTI.
- Comparison of patient characteristics and laboratory findings between those with and without DMSA scan abnormalities.
- Development of a multivariable logistic regression model to create a risk score.
Main Results:
- Of 208 children who underwent DMSA scan, 40 (19%) showed abnormalities.
- Elevated C-reactive protein (CRP), procalcitonin, and creatinine levels were associated with DMSA abnormalities.
- A risk prediction model incorporating procalcitonin (≥4.07 μg/L), creatinine (≥43 μmol/L), and CRP (≥90.4 mg/L) was developed.
Conclusions:
- Serum creatinine, procalcitonin, and CRP are valuable indicators for identifying pediatric patients at risk of abnormal DMSA scans.
- The developed clinical risk prediction model can aid in stratifying children post-febrile UTI.
- Early identification facilitates targeted management to prevent long-term renal complications.
Background:
Children with febrile urinary tract infection (UTI) are at increased risk of kidney scarring which can be identified by a late dimercaptosuccinic acid (DMSA) scan performed ≥ 3 months after the febrile UTI. In this study, we developed a clinical risk prediction model to identify children at risk of an abnormal late DMSA scan after the first febrile UTI.
Methods:
This is a retrospective cohort study of all children diagnosed with their first febrile UTI between January and July 2017, scheduled for a late DMSA scan. Patient characteristics and laboratory findings were compared between patients with and without abnormalities on the DMSA scan. A clinical risk prediction model was developed using the odds ratio of variables in a multivariable logistic regression model to obtain a score for each covariate.
Results:
There were 581 children diagnosed with their first febrile UTI, of which 208 (36%) underwent DMSA scan. Overall, 40 (19%) children had abnormal DMSA scans. A higher proportion of boys with phimosis compared to those without phimosis had DMSA abnormalities (67% vs. 38%, p = 0.019). C-reactive protein (CRP) (108.0 [interquartile range, IQR 41.4-198.4] vs. 32.6 [IQR 11.4-85.2] mg/L, p < 0.001), procalcitonin (10.98 [IQR 0.40-43.72] vs. 0.13 [IQR 0.10-0.24] ng/mL, p < 0.001) and creatinine (41 [IQR 37-46] vs. 37 [IQR 35-40] μmol/L, p < 0.001) were higher in patients with DMSA abnormalities. The clinical risk prediction model included procalcitonin ≥ 4.07 μg/L, creatinine ≥ 43 μmol/L and CRP ≥ 90.4 mg/L.
Conclusion:
Serum creatinine, procalcitonin and CRP may be useful in identifying paediatric patients with first febrile UTI at risk of an abnormal late DMSA scan.
More Related Videos
07:20Author Spotlight: Repetitive Transcranial Magnetic Stimulation Combined with Movement Observation in Cerebral Palsy
Published on: August 9, 2024
07:25Author Spotlight: A Focus on Standardized Salivary Gland Ultrasound Protocol in Connective Tissue Disease Research
Published on: October 13, 2023
Related Concept Videos
01:30Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care
01:27Imaging Studies IV: Magnetic Resonance Imaging
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
01:27Imaging Studies III: Computed Tomography
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT