Abstract | OBJECTIVE: We examined the diagnostic accuracy of routine imaging studies (ultrasonography and micturating cystography) for predicting long-term parenchymal renal damage after a first febrile urinary tract infection. METHODS: This study addressed the secondary objective of a prospective trial evaluating different antibiotic regimens for the treatment of acute pyelonephritis. Data for 300 children < or =2 years of age, with normal prenatal ultrasound results, who completed the diagnostic follow-up evaluation (ultrasonography and technetium-99m-dimercaptosuccinic acid scanning within 10 days, cystography within 2 months, and repeat technetium-99m-dimercaptosuccinic acid scanning at 12 months to detect scarring) were analyzed. Outcome measures were sensitivity, specificity, and negative and positive predictive values for ultrasonography and cystography in predicting parenchymal renal damage on the 12-month technetium-99m-dimercaptosuccinic acid scans. RESULTS: The kidneys and urinary tracts were mostly normal. The acute technetium-99m-dimercaptosuccinic acid scans showed pyelonephritis in 54% of cases. Renal scarring developed in 15% of cases. The ultrasonographic and cystographic findings were poor predictors of long-term damage, showing minor sonographic abnormalities for 12 and reflux for 23 of the 45 children who subsequently developed scarring. CONCLUSIONS:
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Authors | Giovanni Montini, Pietro Zucchetta, Lisanna Tomasi, Enrico Talenti, Waifro Rigamonti, Giorgio Picco, Alberto Ballan, Andrea Zucchini, Laura Serra, Vanna Canella, Marta Gheno, Andrea Venturoli, Marco Ranieri, Valeria Caddia, Carla Carasi, Roberto Dall'amico, Ian Hewitt |
Journal | Pediatrics
(Pediatrics)
Vol. 123
Issue 2
Pg. e239-46
(Feb 2009)
ISSN: 1098-4275 [Electronic] United States |
PMID | 19139086
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Topics |
- Child, Preschool
- Female
- Fever
(etiology)
- Humans
- Infant
- Italy
- Kidney Diseases
(complications, diagnosis, diagnostic imaging, etiology)
- Male
- Predictive Value of Tests
- Prospective Studies
- Radiography
- Radionuclide Imaging
- Reproducibility of Results
- Ultrasonography
- Urinary Tract Infections
(complications, diagnosis, diagnostic imaging, therapy)
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