Ecografía renal con Doppler en el diagnóstico de pielonefritis aguda en niños / Renal ultrasound with Doppler in the diagnosis of acute pyelonephritis in children
Rev. chil. pediatr;
82(5): 402-409, oct. 2011. ilus, tab
Artigo
em Espanhol
| LILACS | ID: lil-612169
Objective: This study evaluates the diagnostic value of Renal Doppler Ultrasound (RDU) in the diagnosis of acute renal involvement among children admitted for a first febrile urinary tract infection (UTI), compared to a Renal Scintigraphy (RS). Methodology: All children admitted during 2009 for a first febrile UTI and positive urinary culture were prospectively studied. All received a RDU and RS with Tc99di-mercaptosuccinic acid during the first 72 hours of hospitalization. Image evaluation was performed blindly. RS was considered to be the gold standard to identify renal involvement. Results: The protocol was completed in 54 children (90 percent). RDU was altered in 36 (66 percent), and RS in 42 (78 percent) of children. Both exams coincided in 78 percent of the children, and in 81 percent of the kidneys. Sensitivity and specificity of RDU for these patients was 78,6 percent and 75 percent (72 percent and 89,6 percent per kidney), respectively. Negative predictive value was 50 percent. RDU detected significantly fewer defects in the left kidney, (p = 0,0026), especially if the defect was localized in the upper pole, and in absence of other associated scintigraphic abnormalities (p = 0,0001). Children with scintigraphic renal involvement showed significant more alterations during the acute phase. Conclusions: RDU is sensitive and specific to detect renal involvement in a child admitted for a febrile UTI, but has a low negative predictive value. Therefore, a negative ultrasound in a patient with inflammatory signs should be confirmed through a scintigraphy, since there are certain sites that are difficult to localize in a sonogram, such as the left superior pole.
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