BACKGROUND AND OBJECTIVE:
The best approach for radiologic investigation in a child after the first febrile urinary tract infection (UTI) remains contentious. Many advocates agree that the detection of high-grade vesicoureteral reflux (VUR) is important because of the increased risk of recurrent UTI and renal scars. The objective was to study the ability of renal bladder ultrasonography (RBUS) and late 6-month technetium-99 dimercaptosuccinic acid (DMSA) renal scans to detect high-grade VUR after first febrile UTI in infants aged <1 year.
A total of 387 infants aged <1 year with first febrile UTI who completed the diagnostic follow-up of RBUS, voiding cystourethrography (VCUG), and late 6-month DMSA scan were enrolled in the study. The ability of RBUS and late 6-month DMSA scan to detect high-grade VUR, including cost and benefit, was assessed.
RBUS findings were abnormal in 95 (24.5%) infants. VUR was found by VCUG in 79 (20.4%) infants, which was high grade (grade IV–V) in 8 (2.1%) infants. Abnormal renal parenchyma, including renal scars, was identified by late 6-month DMSA scan in 22 (5.7%) infants. The sensitivity of abnormal RBUS and late 6-month DMSA scans in detecting high-grade VUR was 50% and 87.5%, respectively, and unnecessary VCUG was reduced by 75.5% and 94.3%, respectively. Abnormal RBUS had higher sensitivity in detecting abnormal DMSA scan than normal RBUS (68.2% and 31.8%, respectively).
Fifty percent of high-grade VUR and 31.8% of abnormal late 6-month DMSA scans were not detected by RBUS screening after a first febrile UTI in infants. Although abnormal late 6-month DMSA scans had higher sensitivity and specificity in detecting high-grade VUR and the ability to detect renal scars, the benefit of this method was limited because of its high cost and radiation exposure.
- Copyright © 2015 by the American Academy of Pediatrics