Top-down approach is possible strategy for predicting breakthrough fUTIs and renal scars in infants.
Pediatr Int
; 59(7): 781-785, 2017 Jul.
Article
em En
| MEDLINE
| ID: mdl-28370971
ABSTRACT
BACKGROUND:
Acute-phase technetium-99 m dimercaptosuccinic acid (DMSA) scintigraphy is recommended for initial imaging in children with febrile urinary tract infection (fUTI). Recently, the importance of identifying patients at risk of recurrent fUTI (r-fUTI) has been emphasized. To clarify the effectiveness of DMSA scintigraphy for predicting r-fUTI in infants, we investigated the relationship between defects on DMSA scintigraphy and r-fUTI.METHODS:
Seventy-nine consecutive infants (male female, 6019) with fUTI were enrolled in this study. DMSA scintigraphy was performed in the acute phase, and patients with defect underwent voiding cystourethrography and chronic-phase (6 months later) DMSA scintigraphy. Patients were followed on continuous antibiotic prophylaxis (CAP).RESULTS:
Defects on acute-phase DMSA scintigraphy were observed in 32 children (40.5%) of 79. The mean follow-up observation period was 17.0 ± 10.1 months. Four patients had r-fUTI (5%). Two of them had defects on DMSA scintigraphy in both the acute phase and chronic phase, and had bilateral vesicoureteral reflux (VUR) grade IV. Two others had r-fUTI without defects on DMSA and did not have VUR. Twelve patients had defect on chronic-phase DMSA scintigraphy and four of them had no VUR.CONCLUSIONS:
The top-down approach is a possible method for predicting r-fUTI in infants and does not miss clinically significant VUR. Also, given that the prevalence of r-fUTI was 5% regardless of the presence of defects on acute-phase DMSA, then, in conjunction with genital hygiene and CAP, acute-phase DMSA might be unnecessary if chronic-phase DMSA is performed for all patients to detect renal scar.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Infecções Urinárias
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Cicatriz
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Compostos Radiofarmacêuticos
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Ácido Dimercaptossuccínico Tecnécio Tc 99m
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Rim
Idioma:
En
Ano de publicação:
2017
Tipo de documento:
Article