Clinical Efficacy of a Top-down Approach for Children with a First Febrile Urinary Tract Infection.
10.3339/jkspn.2017.21.2.114
- Author:
Kyung Mi JANG
1
;
Myung Hee LIM
;
Yong Hoon PARK
;
Saeyoon KIM
Author Information
1. Department of Pediatrics, College of Medicine, Yeungnam University, Daegu, Korea. sysnow88@hanmail.net
- Publication Type:Original Article
- Keywords:
Urinary tract infection;
Tc-99m DMSA;
ultrasonography;
vesicoureteral reflux
- MeSH:
Age Distribution;
Child*;
Cicatrix;
Humans;
Inflammation;
Kidney;
Male;
Methods;
Retrospective Studies;
Succimer;
Technetium Tc 99m Dimercaptosuccinic Acid;
Treatment Outcome*;
Ultrasonography;
Urinary Tract Infections*;
Urinary Tract*;
Vesico-Ureteral Reflux
- From:Childhood Kidney Diseases
2017;21(2):114-120
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: The aim of this study was to determine the clinical characteristics, frequency of renal abnormalities and benefits of a top-down approach in children with their first febrile urinary tract infection (UTI). METHODS: We reviewed 308 patients retrospectively who were admitted to Yeungnam University Hospital and were treated for their first febrile UTI from February 2006 to December 2013. We performed a comparative analysis of laboratory findings and results of imaging techniques including a Tc-99m dimercaptosuccinic acid (DMSA) renal scan. RESULTS: Among the patients, 69% (213/308) were males, and 90% (277/308) had their first UTI episode during infancy. A DMSA renal scan was performed on all patients, and showed positive findings in 60% (184/308) of cases. Laboratory indices of inflammation were significantly higher in the DMSA-positive group (P<0.05). There was a statistically significant difference in the age distribution between the two groups. In the DMSA-positive group, 165 patients underwent voiding cystourethrography (VCUG), and 58 (35%) cases demonstrated vesicoureteral reflux. In total, 110 patients in the DMSA-positive group, underwent repeat scanning at 6 months; 33 children (30%) demonstrated static scarring, but 77 (70%) had improved completely. The concordance of the ultrasonography (US) and VCUG was low. Older patients had more renal scarring. CONCLUSION: DMSA is a sensitive method for assessing the severity of inflammation and kidney injury. However, the ability of US to predict renal parenchymal damage was limited. A top-down approach in children with their first febrile UTI showed significant value.
