Database: Ovid MEDLINE(R) <1996 to March Week 3 2010>
Search Strategy:
-------------------------------------------------------------------------------1 *pyelonephritis/di (192)
2 acute disease/ (74069)
3 acute.tw. or 2 (357406)
4 1 and 3 (95)
5 limit 4 to (male and "all infant (birth to 23 months)") (21)
6 from 5 keep 1-21 (21)
***************************
<1>
Unique Identifier
19620428
Status
MEDLINE
Authors
Brenner M. Bonta D. Eslamy H. Ziessman HA.
Authors Full Name
Brenner, Michele. Bonta, Dacian. Eslamy, Hedieh. Ziessman, Harvey A.
Institution
Russell H. Morgan Department of Radiology, Division of Nuclear Medicine, Johns Hopkins
University and Johns Hopkins Outpatient Center, 601 N Caroline St., JHOC Rm. 3231,
Baltimore, MD 21287, USA.
Title
Comparison of 99mTc-DMSA dual-head SPECT versus high-resolution parallel-hole planar
imaging for the detection of renal cortical defects.
Source
AJR. American Journal of Roentgenology. 193(2):333-7, 2009 Aug.
Abstract
OBJECTIVE: Renal cortical scintigraphy with (99m)Tc dimer captosuccinic acid (DMSA) is
the standard method to detect acute pyelonephritis and cortical scarring. Different acquisition
methods have been used: planar parallel-hole or pinhole collimation and single photon emission
tomography (SPECT). Publications support the superiority of each; few comparative studies
have been reported, with mixed results. We have compared planar parallel-hole cortical
scintigraphy and dual-head SPECT for detection of cortical defects. MATERIALS AND
METHODS: Forty patients (37 children, 3 adults; 9 male, 31 female) were imaged 3 hours after
injection of (99m)Tc-DMSA with dual-head SPECT and planar imaging (posterior, left, and
right posterior oblique views with a parallel-hole collimator). For each patient, planar and
SPECT images were evaluated at different sittings, in random order, by three independent
observers. Twelve cortical segments were scored as normal or reduced uptake. The linear
correlation coefficient for the number of abnormal segments detected between readers,
techniques, and segments was calculated. RESUlTS: No significant difference was seen in the
average number of abnormal segments detected by planar versus SPECT imaging; 2.1 for planar
imaging and 2.2 for SPECT (p = 0.84, two-tailed). For all observers, the average correlation
coefficient for SPECT alone, planar imaging alone, and between techniques (SPECT vs planar
imaging) was high (r = 0.93-0.94). Applying nonparametric Spearman's rank analysis, the
average correlation remained high (r = 0.70-0.75). Correlation between readers, techniques, and
segments for methods and readers was also good (r = 0.69-0.77). CONClUSION: (99m)Tc-DMSA
renal cortical imaging using dual-head SPECT offers no statistically significant diagnostic
advantage over planar imaging for detection of cortical defects.
Publication Type
Comparative Study. Journal Article.
<2>
Unique Identifier
19395784
Status
MEDLINE
Authors
Mohkam M. Asgarian F. Fahimzad A. Sharifian M. Dalirani R. Abdollah Gorgi F.
Authors Full Name
Mohkam, Masoumeh. Asgarian, Fahimeh. Fahimzad, Alireza. Sharifian, Mostafa. Dalirani,
Reza. Abdollah Gorgi, Fatemeh.
Institution
Pediatric Infectious Research Center, Shahid Beheshti University (MC), Tehran, Iran.
mohkamm@yahoo.com
Title
Diagnostic potential of urinary tumor necrosis factor-alpha in children with acute
pyelonephritis.
Source
Iranian journal of Kidney Diseases. 3(2):89-92, 2009 Apr.
Abstract
INTRODUCTION. Tumor necrosis factor-alpha (TNF-alpha) is an important mediator of the
inflammatory response in serious bacterial infections. The aim of this study was to evaluate the
potential of urinary TNF-alpha for diagnosis of acute pyelonephritis in children. MATERIALS
AND METHODS. This study was conducted from March 2006 to December 2007 on children
with confirmed diagnosis of acute pyelonephritis. They all had positive renal scintigraphy scans
for pyelonephritis and leukocyturia. The ratios of urinary TNF-alpha to urine creatinine level
were determined and compared in patients before and after antibiotic therapy. RESULTS.
Eighty-two children (13 boys and 69 girls) with acute pyelonephritis were evaluated. The mean
pretreatment ratio of urinary TNF-alpha to urinary creatinine level was higher than that 3 days
after starting on empirical treatment (P = .03). The sensitivity of this parameter was 91% for
diagnosis of acute pyelonephritis when compared with demercaptosuccinic acid renal
scintigraphy as gold standard. CONCLUSIONS. Based on our findings in children, the level of
urinary TNF-alpha-creatinine ratio is acute increased in pyelonephritis and it decreases after
appropriate therapy with a high sensitivity for early diagnosis of the disease. Further research is
warranted for shedding light on the potential diagnostic role of urinary TNF-alpha in
pyelonephritis in children.
Publication Type
Journal Article. Research Support, Non-U.S. Gov't.
<3>
Unique Identifier
19367005
Status
MEDLINE
Authors
Mohkam M. Karimi A. Habibian S. Sharifian M.
Authors Full Name
Mohkam, Masoumeh. Karimi, Abdollah. Habibian, Saiid. Sharifian, Mostafa.
Institution
Pediatric Infectious Research Center, Shaheed Beheshti University of Medical Sciences, Tehran,
Iran. mohkamm@yahoo.com
Title
Urinary N-acetyl-beta-D-glucosaminidase as a diagnostic marker of acute pyelonephritis in
children.
Source
Iranian journal of Kidney Diseases. 2(1):24-8, 2008 Jan.
Abstract
INTRODUCTION: Prompt diagnosis and localization of pyelonephritis are of great importance
in children. The urinary excretion of enzymes, and in particular N-acetyl-beta-Dglucosaminidase (NAG), is considered a simple noninvasive marker for detection of renal tubular
dysfunction due to pyelonephritis. This study was performed to determine the diagnostic value of
urinary NAG in acute pyelonephritis. MATERIALS AND METHODS: In a quasi-experimental
study conducted on 72 children with confirmed pyelonephritis, we measured urinary NAG,
creatinine, and NAG-creatinine ratio before and after the treatment. Diagnostic values of these
parameters were evaluated by considering the patients before and after the treatment as disease-
positive and disease-negative groups, respectively. RESULTS: The patients were 18 boys (25.0%)
and 54 girls (75.0%) with a mean age of 43.0 +/- 39.0 months. The mean levels of urinary NAG
were 12.20 +/- 6.14 U/L and 5.46 +/- 7.98 U/L before and after the treatment, respectively (P <
.001). The sensitivity and specificity of urinary NAG-creatinine ratio for diagnosis of
pyelonephritis were 73.6% and 77.3%, respectively, with a cutoff point of 10.16 U/g (area under
the curve = 0.76, 95% confidence interval, 0.67 to 0.76). Significantly higher levels of urinary
NAG were found in those who had a negative urine culture at diagnosis (8.8 +/- 10.4 U/L)
compared to those with a positive urine culture (4.5 +/- 8.7 U/L). CONCLUSIONS: We
concluded that urinary NAG is elevated in children with pyelonephritis and it can be considered
as a further criterion in the diagnosis of upper urinary tract infection.
Publication Type
Evaluation Studies. Journal Article. Research Support, Non-U.S. Gov't.
<4>
Unique Identifier
18761823
Status
MEDLINE
Authors
Roed C. Friis-Moller A. Hogh B.
Authors Full Name
Roed, Casper. Friis-Moller, Alice. Hogh, Birthe.
Institution
Hogh Hvidovre Hospital, Borneafdelingen, Hvidovre. casperroed@hotmail.com
Title
[A study of the validity of urinary tract infection diagnosis in children younger than two years
of age at Hvidovre Hospital]. [Danish]
Source
Ugeskrift for Laeger. 170(33):2432-4, 2008 Aug 11.
Abstract
INTRODUCTION: The aim of this study is to validate the diagnosis of urinary tract infection
(UTI) concerning false-positive diagnoses in children younger than two years of age at Hvidovre
Hospital. MATERIALS AND METHODS: The material consists of 89 children (50 girls and 39
boys) diagnosed with acute pyelonephritis from September 2002 until October 2004. Two
patients dropped out as they were diagnosed in other countries. The patient records were
investigated to identify the children who fulfilled the UTI criteria used in the department: 1) Two
mid-stream urine samples with bacterial growth of = 10.000 cfu (colony forming units)/cc, 2)
growth of = 100 cfu/cc in urine obtained by a suprapubic puncture of the bladder or 3) a midstream urine sample with bacterial growth of = 10.000 cfu/cc and a clinical picture of UTI
together with elevated inflammatory laboratory parameters. RESULTS: 70 out of 87 patients
(80%, 95% confidence limits 70-88%) had a valid UTI diagnosis. CONCLUSION: We consider a
diagnostic validity of 80% as satisfactory although our aim is to increase the validity to 90%.
Publication Type
English Abstract. Journal Article. Validation Studies.
<5>
Unique Identifier
18040727
Status
MEDLINE
Authors
Rodriguez LM. Robles B. Marugan JM. Suarez A. Santos F.
Authors Full Name
Rodriguez, Luis Miguel. Robles, Belen. Marugan, Jose Manuel. Suarez, Angeles. Santos,
Fernando.
Institution
Department of Paediatrics, Leon Hospital, Leon, Spain. luism@arrakis.es
Title
Urinary interleukin-6 is useful in distinguishing between upper and lower urinary tract
infections.
Source
Pediatric Nephrology. 23(3):429-33, 2008 Mar.
Abstract
This study was designed to determine whether the measurement of interleukin (IL)-6 in urine is
useful for distinguishing between acute pyelonephritis and lower urinary tract infection. This
observational study was carried out at Leon Hospital (Spain) on 35 patients (ten boys) aged
between 0 and 14 years with urinary tract infection. Urinary levels of IL-6 were determined with
enzyme-linked immunosorbent assay (ELISA) at diagnosis and after recovery. Renal
dimercaptosuccinate acid (DMSA) scan was performed on all patients to discard or confirm
acute pyelonephritis. The mean urinary concentration [x +/- standard deviation (SD)] of IL-6 at
diagnosis was 20.3 +/- 23.3 and 5.3 +/- 9.7 pg/ml in patients with acute pyelonephritis and lower
urinary infection, respectively [95% confidence interval (CI): 2.6-27.4; p < 0.01]. Specificity for a
value of IL-6 >15 pg/ml, was 94.1% (95% CI: 91.1-97.1). Positive predictive value for IL-6 >15
pg/ml was 87.5% (95% CI: 81.1-93.8). IL-6 was undetectable in the urine of both groups of
patients at the time of recovery. Urinary levels of IL-6 are useful in differentiating between upper
and lower urinary tract infection in children. In this clinical setting, a value >15 pg/ml is a strong
indicator of acute pyelonephritis.
Publication Type
Journal Article. Research Support, Non-U.S. Gov't.
<6>
Unique Identifier
18087632
Status
MEDLINE
Authors
Huang DT. Huang FY. Tsai TC. Tsai JD. Chiu NC. Lin CC.
Authors Full Name
Huang, Daniel Tsung-Ning. Huang, Fu Yuan. Tsai, Tsuen Chiuan. Tsai, Jeng Daw. Chiu, Nan
Chang. Lin, Chun Chen.
Institution
Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
Title
Clinical differentiation of acute pyelonephritis from lower urinary tract infection in children.
Source
Journal of Microbiology, Immunology & Infection. 40(6):513-7, 2007 Dec.
Abstract
BACKGROUND AND PURPOSE: To evaluate clinical variables for diagnosing childhood
acute pyelonephritis (APN) when technetium-99m dimercaptosuccinic acid (DMSA) scintigraphy
is not available. METHODS: We retrospectively reviewed the records of 590 children with
febrile UTI seen from January 1999 to February 2004. On the basis of DMSA scintigraphy
performed within 7 days after admission, they were divided into APN (n = 237) or non-APN (n =
353) groups. Gender, age, clinical presentation, absolute neutrophil count, C-reactive protein
(CRP), urinalysis, culture, and sonographic findings were recorded from charts. RESULTS: A
CRP level of > or =66.4 mg/L, in patients with >2 days prior to admission had a sensitivity of
71.6% and a specificity of 72.5% for APN. Similarly, a CRP of >27.3 mg/L in patients with < or
=2 days prior to admission and a white cell count of >14,990/mm3 had sensitivities of 68.6% and
62.0% and specificities of 66.1% and 63.0%, respectively. Combining two or more variables did
not result in better discrimination. CONCLUSIONS: If a DMSA scan is not available, it is
reasonable to treat a febrile UTI as APN if the CRP is >66.4 mg/L in a patient with >2 days of
fever or if the CRP is >27.3 mg/L in a patient febrile for < or =2 days.
Publication Type
Journal Article.
<7>
Unique Identifier
17727746
Status
MEDLINE
Authors
Van den Bruel A. Aertgeerts B. Bruyninckx R. Aerts M. Buntinx F.
Authors Full Name
Van den Bruel, Ann. Aertgeerts, Bert. Bruyninckx, Rudi. Aerts, Marc. Buntinx, Frank.
Institution
Department of General Practice, Katholieke Universiteit and CEBAM, Belgian Centre for
Evidence Based Medicine, Leuven, Belgium. ann.vandenbruel@med.kuleuven.be
Title
Signs and symptoms for diagnosis of serious infections in children: a prospective study in
primary care.
Source
British Journal of General Practice. 57(540):538-46, 2007 Jul.
Other ID
Source: NLM. PMC2099636
Abstract
BACKGROUND: Serious infections in children (sepsis, meningitis, pneumonia, pyelonephritis,
osteomyelitis, and cellulitis) are associated with considerable mortality and morbidity. In
children with an acute illness, the primary care physician uses signs and symptoms to assess the
probability of a serious infection and decide on further management. AIM: To analyse the
diagnostic accuracy of signs and symptoms, and to create a multivariable triage instrument.
DESIGN OF STUDY: A prospective diagnostic accuracy study. SETTING: Primary care in
Belgium. METHOD: Children aged 0-16 years with an acute illness for a maximum of 5 days
were included consecutively. Signs and symptoms were recorded and compared to the final
outcome of these children (a serious infection for which hospitalisation was necessary). Accuracy
was analysed bivariably. Multivariable triage instruments were constructed using classification
and regression tree (CART) analysis. RESULTS: A total of 3981 children were included in the
study, of which 31 were admitted to hospital with a serious infection (0.78%). Accuracy of signs
and symptoms was fairly low. Classical textbook signs (meningeal irritation impaired peripheral
circulation) had high specificity. The primary classification tree consisted of five knots and had
sensitivity of 96.8% (95% confidence interval [CI] = 83.3 to 99.9), specificity 88.5% (95% CI =
87.5 to 89.5), positive predictive value 6.2% (95% CI = 4.2 to 8.7), and negative predictive value
100.0% (95% CI = 99.8 to 100.0), by which a serious infection can be excluded in children testing
negative on the tree. The sign paramount in all trees was the physician's statement 'something is
wrong'. CONCLUSION: Some individual signs have high specificity. A serious infection can be
excluded based on a limited number of signs and symptoms.
Publication Type
Journal Article. Multicenter Study. Research Support, Non-U.S. Gov't.
<8>
Unique Identifier
16894326
Status
MEDLINE
Authors
Guven AG. Kazdal HZ. Koyun M. Aydn F. Gungor F. Akman S. Baysal YE.
Authors Full Name
Guven, Ayfer G. Kazdal, Halis Z. Koyun, Mustafa. Aydn, Funda. Gungor, Frat. Akman,
Sema. Baysal, Yunus Emre.
Institution
Department of Paediatrics, Akdeniz University, School of Medicine, Antalya, Turkey.
Title
Accurate diagnosis of acute pyelonephritis: How helpful is procalcitonin?.
Source
Nuclear Medicine Communications. 27(9):715-21, 2006 Sep.
Abstract
AIM: This prospective study aimed to investigate the diagnostic value of serum procalcitonin
levels in children with acute pyelonephritis documented by Tc-dimercaptosuccinic acid (DMSA)
scintigraphy. METHODS: We compared the symptoms and laboratory findings of fever,
vomiting, abdominal/flank pain, leukocyte count, serum C-reactive protein and procalcitonin
levels with the results of the DMSA scan obtained within the first 72 h after referral in children
who were diagnosed as having acute pyelonephritis. Thirty-three children (31 female and two
male) aged 1-11 years (mean 4.42 years) were enrolled in this prospective study. RESULTS:
Twenty-one of 33 patients (64%) had positive DMSA scans. On the scans obtained after 6
months, five of 21 patients (23.8%) had renal scars. No correlation was found between clinical
and laboratory parameters, alone or combined with each other, and positive DMSA scans. Serum
procalcitonin levels were 0.767+/-0.64 and 1.23+/-1.17 ng . ml in children with normal and
positive DMSA scans, respectively. The cut-off value for procalcitonin using receiver operating
characteristic analysis was 0.9605 ng . ml, while sensitivity and specificity were 86.4% and
36.4%, respectively. However, if the cut-off value was chosen as 2 ng . ml, the sensitivity
increased to 100% while specificity did not change markedly. CONCLUSION: The serum
procalcitonin test, like other commonly used laboratory parameters, e.g. serum C-reactive
protein and white blood cell count, was inadequate in distinguishing renal parenchymal
involvement in acute febrile urinary tract infections.
Publication Type
Journal Article. Research Support, Non-U.S. Gov't.
<9>
Unique Identifier
16791804
Status
MEDLINE
Authors
Chroustova D. Palyzova D. Urbanova I. Kolska M.
Authors Full Name
Chroustova, Daniela. Palyzova, Daniela. Urbanova, Irena. Kolska, Monika.
Institution
Department of Nuclear Medicine, University Hospital Kralovske Vinohrady and 3rd School of
Medicine, Charles University, Prague, Czech Republic. chroust@fnkv.cz
Title
Results of a five-year study of 99mTc DMSA renal scintigraphy in children and adolescents
following acute pyelonephritis.
Source
Nuclear Medicine Review. 9(1):46-50, 2006.
Abstract
BACKGROUND: Renal scintigraphy, generally using 99mTc-DMSA, is the accepted reference
standard for detection of renal cortical changes. The timing of the test, i.e., whether an acute
99mTc-DMSA scan, a follow-up only or both scans should be performed, however, remains open
to discussion. In our study, a six-month follow- up DMSA scan was performed in all the children
diagnosed with a first attack of acute pyelonephritis (APN) in two large paediatric clinics of
Charles University's 3rd School of Medicine in Prague during a five-year period. All diagnoses
were confirmed by a paediatric nephrologist. MATERIAL AND METHODS: 382 children (267
girls, 115 boys) aged between 7 months and 19 years were included in the study. For analytical
purposes, the patients were divided into 4 age groups: I--less than 1 year of age, II--1-5 years, III-5-10 years, and IV--10-19 years. In all children younger than five years, a micturition
cystourethrogram (MCUG) for detection of vesicoureteric reflux (VUR) was performed between
one and three months after the APN episode. Static renal scintigraphy, using an HR collimator
with parallel holes was performed using a planar Gamma camera MB 9200 (Gamma Budapest)
in all children six months after APN, with a complement of pinhole images, SPECT or PSPECT
of the kidneys. RESULTS: 1. In group I, all four children with positive VUR on MCUG had a
pathological DMSA scan, while only two of the 32 patients with negative VUR had a pathological
DMSA. 2. In group II, 17 children had VUR on MCUG, six of them with a pathological and 11
with a normal DMSA scan. Most of the 221 children without VUR had a normal DMSA
scintigraphy; pathological findings were present in 17 children only. 3. In group III, all children
with VUR, but only 5 out of 53 without VUR, had a pathological DMSA scan. 4. Five out of 50
children in group IV had a pathological DMSA. CONCLUSIONS: APN occurred most
frequently in group II (62.3%, or 238 children) and ranged between 10-15% in the remaining
groups. APN was found very frequently in boys less than one year old and showed a marked
decrease with increasing age. Among girls, however, APN incidence was observed to increase
with age. Pathological renal changes were present in children with, as well as without, VUR. The
incidence of pathological DMSA findings six months after APN was relatively low (44/382
patients, or 11.5%). Regular monitoring of these children is very important for detection of renal
scarring.
Publication Type
Journal Article.
<10>
Unique Identifier
15893462
Status
MEDLINE
Authors
Bigot S. Leblond P. Foucher C. Hue V. D'Herbomez M. Foulard M.
Authors Full Name
Bigot, S. Leblond, P. Foucher, C. Hue, V. D'Herbomez, M. Foulard, M.
Institution
Clinique de pediatrie, hopital Jeanne-de-Flandre, Lille, France. sandra_bigot@hotmail.com
Title
[Usefulness of procalcitonin for the diagnosis of acute pyelonephritis in children]. [French]
Source
Archives de Pediatrie. 12(7):1075-80, 2005 Jul.
Abstract
BACKGROUND: Acute pyelonephritis can induce parenchymal scarring. The aim of this study
was to evaluate the usefulness of procalcitonin (PCT) to predict renal involvement in febrile
children with urinary tract infection (UTI). METHODS: In a prospective study serum PCT was
measured and compared with others commonly used inflammatory markers in children admitted
to the emergency unit with acute pyelonephritis. Renal parenchymal involvement was assessed by
a (99 m)Tc-labeled dimercaptosuccinic acid (DMSA) renal scar performed in the first 3 days
after the admission. RESULTS: Among 42 enrolled patients, 19 (45%) had acute renal
involvement (Group A) ; 23 (55%) (Group B) had normal DMSA scan (n = 16), or old scarring (n
= 4) or various anomalies related to uropathy (n = 3). In group A, the mean PCT level was
significantly higher than in the group B (5.4 ng/ml, vs 0.4 ng /ml, p < 10(-5)). In these 2 groups,
mean C reactive protein (CRP) levels were 99.1 mg/l and 44.6 mg/l respectively (p < 0.001). For a
level of serum PCT > or = 0.5 ng/ml, the sensitivity and specificity to predict the renal
involvement were 100% and 87% respectively; for a level> or= 20 mg/l CRP had a sensitivity of
94% but a specificity of 30%. CONCLUSION: Serum PCT levels were significantly increased in
febrile children with UTI when acute renal parenchymal involvement was present. PCT seems a
better marker than CRP for the prediction of patients at risk of renal lesions.
Publication Type
English Abstract. Journal Article.
<11>
Unique Identifier
15286264
Status
MEDLINE
Authors
Pecile P. Miorin E. Romanello C. Falleti E. Valent F. Giacomuzzi F. Tenore A.
Authors Full Name
Pecile, Paolo. Miorin, Elisabetta. Romanello, Carla. Falleti, Edmondo. Valent, Francesca.
Giacomuzzi, Francesco. Tenore, Alfred.
Institution
Department of Pediatrics, School of Medicine, University of Udine, Piazzale S.M. della
Misericovolio Udine 33100, Italy. paolo.pecile@uniud.it
Title
Procalcitonin: a marker of severity of acute pyelonephritis among children.
Source
Pediatrics. 114(2):e249-54, 2004 Aug.
Abstract
OBJECTIVE: Febrile urinary tract infection (UTI) is a common problem among children. The
diagnosis and management of acute pyelonephritis is a challenge, particularly during infancy.
The distinction between acute pyelonephritis and UTI without renal involvement is very
important, because renal infection may cause parenchymal scarring and thus requires more
aggressive investigation and follow-up monitoring. However, this distinction is not easy among
children, because common clinical findings and laboratory parameters are nonspecific, especially
among young children. In an attempt to differentiate acute pyelonephritis from febrile UTI
without renal lesions in a group of 100 children, we measured serum levels of procalcitonin
(PCT), a new marker of infection. The objective of the study was to determine the accuracy of
PCT measurements, compared with C-reactive protein (CRP) measurements, in diagnosing acute
renal involvement during febrile UTI and in predicting subsequent scars, as assessed with
99mTc-dimercaptosuccinic acid (DMSA) scintigraphy. DESIGN: Serum CRP levels, erythrocyte
sedimentation rates, leukocyte counts, and PCT levels were measured for 100 children, 1 month
to 13 years of age, admitted for suspected febrile UTI (first episode). Renal parenchymal
involvement was evaluated with DMSA scintigraphy within 5 days after admission. The DMSA
study was repeated 6 months later if the initial results were abnormal. RESULTS: The mean
PCT level was significantly higher in acute pyelonephritis than in UTI without renal lesions (4.48
+/- 5.84 ng/mL vs 0.44 +/- 0.30 ng/mL). In these 2 groups, the mean CRP levels were 106 +/- 68.8
mg/L and 36.4 +/- 26 mg/L, mean erythrocyte sedimentation rates were 79.1 +/- 33 mm/hour and
58.5 +/- 33 mm/hour, and leukocyte counts were 18 492 +/- 6839 cells/mm3 and 16 741 +/- 5302
cells/mm3, respectively. For the prediction of acute pyelonephritis, the sensitivity and specificity
of PCT measurements were 83.3% and 93.6%, respectively; CRP measurements had a sensitivity
of 94.4% but a specificity of only 31.9%. Positive and negative predictive values for prediction of
renal involvement with PCT measurements were 93.7% and 83% and those with CRP
measurements were 61.4% and 83.3%, respectively. When inflammatory markers were
correlated with the severity of the renal lesions, as assessed with DMSA scintigraphy, a highly
significant correlation with both PCT and CRP levels was found. However, when the 2
parameters were correlated with renal scarring in follow-up scans, a significant positive
association was found only for PCT levels. CONCLUSIONS: Serum PCT levels may be a
sensitive and specific measure for early diagnosis of acute pyelonephritis and determination of
the severity of renal parenchymal involvement. Therefore, this measurement could be useful for
the treatment of children with febrile UTIs, allowing prediction of patients at risk of permanent
parenchymal renal lesions.
Publication Type
Clinical Trial. Comparative Study. Journal Article.
<12>
Unique Identifier
12792386
Status
MEDLINE
Authors
Prat C. Dominguez J. Rodrigo C. Gimenez M. Azuara M. Jimenez O. Gali N. Ausina V.
Authors Full Name
Prat, Cristina. Dominguez, Josep. Rodrigo, Carlos. Gimenez, Montse. Azuara, Marta.
Jimenez, Orlando. Gali, Nuria. Ausina, Vicenc.
Institution
Serveis de Microbiologia, Hospital Universitari Germans Trias i Pujol, C/Canyet s/n, 08916
Badalona, Spain. crisprat@ns.hugtip.scs.es
Title
Elevated serum procalcitonin values correlate with renal scarring in children with urinary tract
infection.
Source
Pediatric Infectious Disease Journal. 22(5):438-42, 2003 May.
Abstract
BACKGROUND: Urinary tract infection (UTI) in young children carries the risk of
parenchymal damage and sequelae. The location of the infection within the urinary tract
influences decisions regarding both therapeutics and follow-up. Because clinical features and
laboratory markers of infection at an early age are not specific, it is difficult to make a distinction
between lower UTI and acute pyelonephritis. Procalcitonin (PCT) has been studied as a marker
of severe bacterial infection. The aim of this study was to test the usefulness of PCT
concentration in serum to distinguish between uncomplicated UTI and severe acute
pyelonephritis with renal scars. METHODS: PCT was measured by immunoluminometric assay
in serum samples from children with microbiologically documented infection. Severe renal
involvement was assessed by 99mTc-dimercaptosuccinic acid gammagraphy done 5 to 6 months
after the episode to check for the presence of parenchymal scars. C-reactive protein (CRP) and
leukocyte count were also measured. RESULTS: PCT at presentation showed a significant
correlation (P < 0.001) with the presence of renal scars in children with UTI. Using a cutoff of 1
ng/ml for PCT and 20 mg/l for CRP, sensitivity and specificity in distinguishing between urinary
tract infection with and without renal damage were 92.3 and 61.9%, respectively, for PCT and
92.3 and 34.4% for CRP. Positive and negative predictive values were 32 and 97.5%,
respectively, for PCT and 23 and 95%, respectively, for CRP. CONCLUSIONS: A low PCT
value at admission indicates a low risk of long term renal scarring. Increased PCT values at
admission correlate with the presence of scars. PCT values have proved to be more specific than
CRP and leukocyte count for identifying patients who might develop renal damage.
Publication Type
Comparative Study. Journal Article.
<13>
Unique Identifier
12775285
Status
MEDLINE
Authors
Lai SW. Ng KC.
Authors Full Name
Lai, Shih-Wei. Ng, Kim-Choy.
Institution
Department of Community Medicine, China Medical College Hospital, Taichung City, Taiwan.
Title
Retrospective analysis of inflammatory parameters in acute pyelonephritis.
Source
Scandinavian Journal of Urology & Nephrology. 37(3):250-2, 2003.
Abstract
OBJECTIVE: Different parameters were compared in children with acute pyelonephritis in
order to facilitate the early detection of vesicoureteral reflux (VUR) in primary healthcare
settings. MATERIAL AND METHODS: This was a cross-sectional, hospital-based study. A total
of 149 children with confirmed acute pyelonephritis were retrospectively analyzed between
January 1999 and December 2000. The primary factors studied were body temperature, Creactive protein level, white blood cell count and neutrophil ratio. RESULTS: The study
population comprised 82 males (55.0%) and 67 females (45.0%). The mean age of the patients
was 2.7 +/- 3.9 years (age range 1 day to 18 years; 75% <3 years old). Of 123 patients who
underwent voiding cystourethrography, 34 (27.6%) had VUR. When raised C-reactive protein,
leukocytosis and raised neutrophil ratio occurred together, the specificity and positive predictive
value for predicting VUR were obviously increased, but sensitivity was radically decreased. After
controlling for the other covariates, multivariate logistic regression analysis showed that factors
significantly related to VUR were age (odds ratio = 1.3, 95% confidence interval 1.02-1.67; p <
0.05) and raised neutrophil ratio (odds ratio = 4.2, 95% confidence interval 1.1-16.5; p < 0.05).
CONCLUSIONS: Our findings emphasize that the prevalence of VUR in children with acute
pyelonephritis is extremely high. If a raised neutrophil ratio is observed, the potential risk of
VUR is significantly increased in patients with clinically suspected acute pyelonephritis. Hence,
the neutrophil ratio is recommended as an excellent parameter for predicting VUR.
Publication Type
Journal Article.
<14>
Unique Identifier
12771787
Status
MEDLINE
Authors
Weiser AC. Amukele SA. Leonidas JC. Palmer LS.
Authors Full Name
Weiser, Adam C. Amukele, Samuel A. Leonidas, John C. Palmer, Lane S.
Institution
Division of Pediatric Urology, Schneider Children's Hospital/Long Island Jewish Medical
Center, New Hyde Park, New York, USA.
Title
The role of gadolinium enhanced magnetic resonance imaging for children with suspected acute
pyelonephritis.
Source
Journal of Urology. 169(6):2308-11, 2003 Jun.
Abstract
PURPOSE: The diagnosis of pyelonephritis is primarily clinical. However, the history and
physical findings can be confusing in children, leading to adjunctive nuclear renal cortical
scintigraphic studies (99mtechnetium dimercapto-succinic acid [DMSA]) to confirm the
diagnosis. Nonetheless, ambiguity occurs when differentiating between acute pyelonephritis and
chronic scarring. We report our initial experience with gadolinium enhanced inversion recovery
magnetic resonance imaging (MRI) to diagnose acute pyelonephritis. MATERIALS AND
METHODS: Nine patients 7 months to 18 years old (mean age 81 months) underwent MRI to
confirm radiographically a clinical suspicion of acute pyelonephritis. All patients had at least 1
prior episode of clinical pyelonephritis. Data were collected to determine whether acute
pyelonephritic changes could be differentiated from chronic pyelonephritis on the basis of MRI
characteristics. RESULTS: Of the 9 patients 4 were identified as having acute pyelonephritis on
MRI (persistently high signal intensity after gadolinium), 2 demonstrated evidence of
postpyelonephritic scar (parenchymal loss without change in signal intensity), 1 had evidence of
acute pyelonephritis and chronic changes, and 2 had a completely normal examination
(decreased signal intensity after gadolinium). At our institution the billable cost of MRI to the
patient is $1,329, while the billable cost of 99mtechnetium DMSA is $1,459. All patients younger
than 6 years required intravenous sedation for MRI, whereas 70% of those younger than 6 years
require intravenous sedation for DMSA scanning at our institution. MRI provided greater
anatomical detail regarding the renal architecture without radiation exposure, and allowed the
unambiguous diagnosis of acute versus chronic pyelonephritis scar in a 1-time (versus often
multipart for DMSA) imaging study. CONCLUSIONS: In cases where adjunctive imaging
studies are useful to make a diagnosis gadolinium enhanced inversion recovery magnetic
resonance imaging allows the detection of acute pyelonephritis rapidly, cost-effectively and safely
in the pediatric population.
Publication Type
Journal Article.
<15>
Unique Identifier
12529459
Status
MEDLINE
Authors
Hoberman A. Charron M. Hickey RW. Baskin M. Kearney DH. Wald ER.
Authors Full Name
Hoberman, Alejandro. Charron, Martin. Hickey, Robert W. Baskin, Marc. Kearney, Diana
H. Wald, Ellen R.
Institution
Department of Pediatrics, University of Pittsburgh School of Medicine and Children's Hospital
of Pittsburgh, Pittsburgh 15213-2583, USA. hoberman@chp.edu
Title
Imaging studies after a first febrile urinary tract infection in young children.
Comments
Comment in: N Engl J Med. 2003 May 1;348(18):1812-4; author reply 1812-4; PMID:
12724491], Comment in: N Engl J Med. 2003 Jan 16;348(3):251-2; PMID: 12529467], Comment
in: N Engl J Med. 2003 May 1;348(18):1812-4; author reply 1812-4; PMID: 12728914], Comment
in: N Engl J Med. 2003 May 1;348(18):1812-4; author reply 1812-4; PMID: 12728913]
Source
New England Journal of Medicine. 348(3):195-202, 2003 Jan 16.
Abstract
BACKGROUND: Guidelines from the American Academy of Pediatrics recommend obtaining
a voiding cystourethrogram and a renal ultrasonogram for young children after a first urinary
tract infection; renal scanning with technetium-99m-labeled dimercaptosuccinic acid has also
been endorsed by other authorities. We investigated whether imaging studies altered
management or improved outcomes in young children with a first febrile urinary tract infection.
METHODS: In a prospective trial involving 309 children (1 to 24 months old), an ultrasonogram
and an initial renal scan were obtained within 72 hours after diagnosis, contrast voiding
cystourethrography was performed one month later, and renal scanning was repeated six months
later. RESULTS: The ultrasonographic results were normal in 88 percent of the children (272 of
309); the identified abnormalities did not modify management. Acute pyelonephritis was
diagnosed in 61 percent of the children (190 of 309). Thirty-nine percent of the children who
underwent cystourethrography (117 of 302) had vesicoureteral reflux; 96 percent of these
children (112 of 117) had grade I, II, or III vesicoureteral reflux. Repeated scans were obtained
for 89 percent of the children (275 of 309); renal scarring was noted in 9.5 percent of these
children (26 of 275). CONCLUSIONS: An ultrasonogram performed at the time of acute illness
is of limited value. A voiding cystourethrogram for the identification of reflux is useful only if
antimicrobial prophylaxis is effective in reducing reinfections and renal scarring. Renal scans
obtained at presentation identify children with acute pyelonephritis, and scans obtained six
months later identify those with renal scarring. The routine performance of urinalysis, urine
culture, or both during subsequent febrile illnesses in all children with a previous febrile urinary
tract infection will probably obviate the need to obtain either early or late scans. Copyright 2003
Massachusetts Medical Society
Publication Type
Clinical Trial. Journal Article. Multicenter Study. Randomized Controlled Trial. Research
Support, Non-U.S. Gov't.
<16>
Unique Identifier
12107804
Status
MEDLINE
Authors
Smolkin V. Koren A. Raz R. Colodner R. Sakran W. Halevy R.
Authors Full Name
Smolkin, Vladislav. Koren, Ariel. Raz, Raul. Colodner, Raul. Sakran, Waheeb. Halevy,
Raphael.
Institution
Pediatric Nephrology Unit, B Ha'Emek Medical Center, Afula, Israel. vlsmolkin@yahoo.com
Title
Procalcitonin as a marker of acute pyelonephritis in infants and children.
Comments
Comment in: Pediatr Nephrol. 2003 Jul;18(7):726; PMID: 12721819]
Source
Pediatric Nephrology. 17(6):409-12, 2002 Jun.
Abstract
In the absence of specific symptomatology in children, the early diagnosis of acute
pyelonephritis is a challenge, particularly during infancy. In an attempt to differentiate acute
pyelonephritis from lower urinary tract infection (UTI), we measured serum procalcitonin (PCT)
levels and compared these with other commonly used inflammatory markers. We evaluated the
ability of serum PCT levels to predict renal involvement, as assessed by dimercaptosuccinic acid
(DMSA) scintigraphy. Serum C-reactive protein (CRP), leukocyte counts, and PCT levels were
measured in 64 children admitted for suspected UTI. Renal parenchymal involvement was
assessed by (99m)Tc-DMSA scintigraphy in the first 7 days after admission. In acute
pyelonephritis, the median PCT level was significantly higher than in the lower UTI group (3.41,
range 0.36-12.4 microg/l vs. 0.13, range 0.02-2.15 microg/l, P<0.0001). In these two groups,
respectively, median CRP levels were 120 (range 62-249 mg/l) and 74.5 (range 14.5-235 mg/l,
P=0.012) and leukocyte counts were 15,910/mm(3) (range 10,200-26,900) and 14,600/mm(3)
(range 8,190-26,470, P=0.34). For the prediction of acute pyelonephritis, the sensitivity and
specificity of PCT were 94.1% and 89.7%, respectively; CRP had a sensitivity of 100%, but a
specificity of 18.5%. We conclude that serum PCT may be an accurate marker for early
diagnosis of acute pyelonephritis.
Publication Type
Journal Article.
<17>
Unique Identifier
12089883
Status
MEDLINE
Authors
Pacanowska B. Jarmolinski T. Zimon T. Dudarenko G.
Authors Full Name
Pacanowska, Beata. Jarmolinski, Tomasz. Zimon, Tomasz. Dudarenko, Grazyna.
Institution
Oddzial Nefrologii ze Stacja Dializ, Specjalistycznego Samodzielnego Publicznego Zakladu
Opieki Zdrowotnej nad Dzieckiem i Mlodzieza w Szczecinie.
Title
[Acute pyelonephritis--clinical picture and the main diagnostic and therapeutic problems in
children]. [Polish]
Source
Polski Merkuriusz Lekarski. 12(70):261-4, 2002 Apr.
Abstract
The aim of the study was to determine the main clinical and organising difficulties affecting
quality and efficacy of medical care in children with acute pyelonephritis (AP). 41 children aged
3 wk--17 yr 4 mo hospitalized for AP at the Department of Nephrology, District Children's
Hospital, Szczecin, Poland in 2000 were investigated. Epidemiologic and demographic data,
history, clinical presentation, auxiliary investigations, treatment and ambulatory follow-up were
analysed. Instead of typical clinical picture neither diagnostic management nor the therapy
fulfilled accepted standards. The main problems found were: delay of referral to hospital by
primary care doctor, misdiagnosis or inaccurate primary diagnosis followed by insufficient
treatment, difficulties with performing simple ambulatory tests (urinalysis, urine culture,
ultrasonography) before hospitalisation and lack of co-operation between parents and
nephrological outpatient clinic after discharge. For reflux and obstructive nephropathy, often
presenting as urinary tract infection, are still the main cause of chronic renal failure in children
in Poland the special attention was paid to necessity of thorough education of family doctors in
the subject of management of such cases as well as improvement of accessibility to specialistic
care.
Publication Type
English Abstract. Journal Article.
<18>
Unique Identifier
11793131
Status
MEDLINE
Authors
Ilyas M. Mastin ST. Richard GA.
Authors Full Name
Ilyas, Mohammad. Mastin, Suzanne T. Richard, George A.
Institution
Division of Nephrology, Department of Pediatrics, College of Medicine, University of Florida,
Gainesville, FL 32610-0296, USA.
Title
Age-related radiological imaging in children with acute pyelonephritis.
Source
Pediatric Nephrology. 17(1):30-4, 2002 Jan.
Abstract
Accurate diagnosis of acute pyelonephritis (APN) using clinical and laboratory parameters is
often difficult in children. The aims of this retrospective study were twofold. Firstly, to correlate
the clinical and laboratory manifestations of APN with the results of the dimercaptosuccinic acid
(DMSA) renal scan in different age groups. Secondly, to compare the DMSA renal scan, renal
ultrasonography (RUS), and voiding cystourethrography (VCUG) in patients with clinical APN.
The DMSA renal scan was utilized as the gold standard for renal involvement. We determined
the sensitivity of these tests in febrile urinary tract infections (UTI) in three age groups: group I
less than 2 years; group II 2-8 years; group III older than 8 years. During the period January
1992 through December 1998, 222 children presented with a febrile UTI. All patients had a
DMSA renal scan, 208 had contrast VCUG, and 163 had RUS. The clinical and laboratory
manifestation of pyelonephritis correlated better with a positive DMSA renal scan in the older
children than in the younger children; 85% of the DMSA renal scans were positive in group III;
69% in group II; 48% in group I (P<0.001). Vesicoureteral reflux detected by contrast VCUG
was more prevalent in the younger age groups. Although high grades of reflux (grade IV-V)
correlated better with a positive DMSA renal scan, it did not reach a level of statistical
significance (P>0.05). RUS did not correlate with a positive DMSA renal scan in any age group.
Publication Type
Journal Article.
<19>
Unique Identifier
10654988
Status
MEDLINE
Authors
Fretzayas A. Moustaki M. Gourgiotis D. Bossios A. Koukoutsakis P. Stavrinadis C.
Authors Full Name
Fretzayas, A. Moustaki, M. Gourgiotis, D. Bossios, A. Koukoutsakis, P. Stavrinadis, C.
Institution
P&A Kyriakou Children's Hospital, Second Department of Pediatrics, University of Athens,
Thibon and Levadias St,Goudi, Athens 115-27, Greece. march193@hol.gr
Title
Polymorphonuclear elastase as a diagnostic marker of acute pyelonephritis in children.
Source
Pediatrics. 105(2):E28, 2000 Feb.
Abstract
OBJECTIVE: Experimental evidence suggests that neutrophils and their metabolites play an
important role in the pathogenesis of pyelonephritis. The aim of this study was to investigate the
diagnostic value of polymorphonuclear elastase-a(1)-antitrypsin complex (E-a(1)-Pi) for the
detection of acute pyelonephritis in children. METHODS: Eighty-three patients, 29 boys and 54
girls, 25 days to 14 years of age, with first-time symptomatic urinary tract infection were
prospectively studied. Fifty-seven healthy children served as controls. Dimercaptosuccinic acid
(DMSA) scan and voiding cystourethrography were performed in all patients. Plasma and
urinary E-a(1)-Pi, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), neutrophil
count, urinary N-acetyl-beta-glucosaminidase (NAG), N-acetyl-beta-glucosaminidase b (NAG b),
and creatinine levels were measured in all patients on admission and 3 days after the
introduction of antibiotics. The same markers were also measured in the control subjects.
RESULTS: Planar DMSA scintigraphy demonstrated changes of acute pyelonephritis in 30 of 83
children (group A). It was normal in the remaining 53 children (group B). The sex and age
distributions were not significantly different between the 2 groups, as well as between the
patients and the control subjects (group C). Nineteen of the 53 children with a normal DMSA
had body temperature >/=38 degrees C, whereas all but 4 children with abnormal DMSA had
temperature >/=38 degrees C. Therefore, the temperature was significantly different between
these 2 groups. The sensitivity and specificity of fever (>/=38 degrees C) as an indicator of renal
involvement based on isotopic findings were 86% and 64%, respectively. Given the significant
number of the febrile children with normal DMSA scintiscans, group B was subdivided into B(1)
with 19 febrile children (14 boys and 5 girls) and B(2) with 34 children whose body temperature
was below 38 degrees C (8 boys and 26 girls). The sex and age distribution was significantly
different between groups B(1) and B(2). The mean age of group B(1) was.78 years (range: 28
days to 9 years; median:.25 years; standard deviation: 2.1). All but 1 child in this group were
younger than 1 year of age. In contrast, in group B(2), there were only 4 infants, the remaining
30 children were older than 2.5 years (mean age: 6 years; median: 7 years; standard deviation:
3.5; range: 34 days to 12 years). The mean duration of fever before hospital admission was 2.8
days for group A and 1.8 days for group B(1). This difference was not statistically significant.
Similarly, body temperature was not significantly different between these 2 groups. The
distribution of plasma E-a(1)-Pi values was normal in the control subjects. The sensitivity and
specificity of plasma E-a(1)-Pi, as an indicator of renal involvement, were 96% and 50%,
respectively, taking the 95th percentile of the reference range as a cutoff value. However,
considering as a cutoff value the level of 72 microg/dL (95th percentile of group B(2)), its
sensitivity and specificity were 74% and 86%, respectively. Plasma E-a(1)-Pi levels were
significantly elevated in group A compared with group B and in both groups, the plasma E-a(1)Pi values were significantly higher than in the control subjects. A significant difference also was
noticed between group A and each of the subgroups B(1) and B(2) and also between the
subgroups themselves. Plasma E-a(1)-Pi concentrations correlated significantly with neutrophil
count in groups A (r =.3), B (r =.4), and B(2) (r =.46), but the correlation was not significant in
group B(1.) ESR levels showed, among the different groups, similar differences with those of Ea(1)-Pi values. Unlike E-a(1)-Pi, CRP levels were comparable between groups A and B(1), which
both consisted of febrile children. Neutrophil count was not significantly different between
subgroups B(1) and B(2). (ABSTRACT TRUNCATED)
Publication Type
Journal Article.
<20>
Unique Identifier
9832579
Status
MEDLINE
Authors
Benador N. Siegrist CA. Gendrel D. Greder C. Benador D. Assicot M. Bohuon C. Girardin
E.
Authors Full Name
Benador, N. Siegrist, C A. Gendrel, D. Greder, C. Benador, D. Assicot, M. Bohuon, C.
Girardin, E.
Institution
Department of Pediatrics, Children's Hospital, Geneva, Switzerland.
Title
Procalcitonin is a marker of severity of renal lesions in pyelonephritis.
Source
Pediatrics. 102(6):1422-5, 1998 Dec.
Abstract
OBJECTIVE: In an attempt to differentiate acute pyelonephritis from lower urinary tract
infection (UTI), we measured serum procalcitonin levels, a recently described marker of
infection. We compared it with other commonly used inflammatory markers and evaluated its
ability to predict renal involvement as assessed by dimercaptosuccinic acid (DMSA) scintigraphy.
METHODS: Serum C-reactive protein, leukocyte counts, and procalcitonin levels were measured
in 80 children, 1 month to 16 years of age, admitted for suspected pyelonephritis. Renal
involvement was assessed by 99mTe-DMSA scintigraphy in the first 5 days after admission. The
examination was repeated at least 3 months later if the first result was abnormal. RESULTS: In
lower UTI, the mean procalcitonin (PCT) was 0.38 micrograms/L +/- 0.19 compared with 5.37
micrograms/L +/- 1.9 in pyelonephritis. In these two groups, respectively, leukocyte counts were
10939/mm3 +/- 834 and 17429/mm3 +/- 994, and C-reactive protein (CRP) levels were 30.3 mg/L
+/- 7.6 and 120.8 mg/L +/- 8.9. When inflammatory markers were correlated to the severity of the
renal lesion as ranked by DMSA scintigraphy, we found a highly significant correlation with
plasma levels of PCT, but borderline significance with CRP and none with leukocyte counts.
Patients without vesicoureteral reflux had a mean PCT of 5.16 micrograms/L +/- 2.33, which was
not significantly different from that in patients with reflux who had a mean PCT of 5.76
micrograms/L +/- 3.49. For the prediction of renal lesions at admission, CRP had a sensitivity of
100% and a specificity of 26.1%. The sensitivity and specificity of PCT were 70.3% and 82.6%,
respectively. CONCLUSION: We conclude that serum PCT levels were increased significantly in
children with febrile UTI when renal parenchymal involvement (assessed by DMSA
scintigraphy) was present and allowed for prediction of patients at risk of severe renal lesions.
Publication Type
Journal Article. Research Support, Non-U.S. Gov't.
<21>
Unique Identifier
9028852
Status
MEDLINE
Authors
Lavocat MP. Granjon D. Allard D. Gay C. Freycon MT. Dubois F.
Authors Full Name
Lavocat, M P. Granjon, D. Allard, D. Gay, C. Freycon, M T. Dubois, F.
Institution
Department of Pediatrics, CHU de Saint Etienne, Hopital Nord, F-42055 Saint Etienne Cedex,
France.
Title
Imaging of pyelonephritis.
Source
Pediatric Radiology. 27(2):159-65, 1997 Feb.
Abstract
OBJECTIVE: Accurate diagnosis of pyelonephritis using clinical and laboratory parameters is
often difficult, especially in children. The main aims of this prospective study were to compare
the value of different imaging techniques [renal sonography, cortical scintigraphy with
technetium-99m dimercaptosuccinic acid (99mTc DMSA) and computed tomography (CT)] in
detecting renal involvement in acute urinary tract infections and to determine the sensitivity of
DMSA scans for permanent renal scars 6 months later. MATERIALS AND METHODS:
Between February 1992 and January 1993, 55 children admitted to our pediatric unit with febrile
symptomatic urinary tract infections were eligible for analysis. Ultrasonography (US), DMSA
scanning and micturating cystourethrography were performed in every case. Only 18 children
underwent CT. A second DMSA scan was performed in 48 children a mean of 7.5 months after
the first. RESULTS: US abnormalities were found in 25 children (45 %). The first DMSA scan
showed a parenchymal aspect suggestive of pyelonephritis in 51 patients (93 %). Among the 18
patients studied by CT, 14 had abnormalities. Normal US findings did not rule out renal
parenchymal involvement. Scintigraphy appeared to be more sensitive than CT for renal
involvement. The frequency and degree of initial renal parenchymal damage seemed to correlate
with vesicoureteral reflux, but the most severe initial parenchymal defects were not associated
with marked clinical or laboratory manifestations. Repeat DMSA scans, performed on 45
kidneys with abnormalities at the first examination, showed resolution in 19, improvement in 16,
persistence in 8 and deterioration in 2. The prevalence of vesicoureteral reflux was not higher in
patients with renal scarring on the second DMSA scan than in patients whose scans showed an
improvement. CONCLUSION: DMSA scans should be considered as a reference in the detection
and follow-up of renal scarring associated with acute urinary tract infection as this technique is
more sensitive than US and CT, the latter being unsuitable because it entails radiation exposure
and sedation of patients.
Publication Type
Comparative Study. Journal Article.