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Top‐down approach is possible strategy for predicting breakthrough fUTIs and renal scars in infants
Author(s) -
Kawai Shina,
Kanai Takahiro,
Hyuga Taiju,
Nakamura Shigeru,
Aoyagi Jun,
Ito Takane,
Saito Takashi,
Odaka Jun,
Furukawa Rieko,
Aihara Toshinori,
Nakai Hideo
Publication year - 2017
Publication title -
pediatrics international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.49
H-Index - 63
eISSN - 1442-200X
pISSN - 1328-8067
DOI - 10.1111/ped.13279
Subject(s) - medicine , cystourethrography , vesicoureteral reflux , scintigraphy , dimercaptosuccinic acid , urinary system , urology , radiology , reflux , disease
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, 60:19) 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.