Top-down approach is possible strategy for predicting breakthrough fUTIs and renal scars in infants.

Abstract

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.

• Authors: Shina Kawai, Takahiro Kanai, Taiju Hyuga, Shigeru Nakamura, Jun Aoyagi, Takane Ito, Takashi Saito, Jun Odaka, Rieko Furukawa, Toshinori Aihara, Hideo Nakai
• Journal: Pediatrics international : official journal of the Japan Pediatric Society (Pediatr Int) Vol. 59 Issue 7 Pg. 781-785 (Jul 2017) ISSN: 1442-200X [Electronic] Australia
• PMID: 28370971 (Publication Type: Clinical Trial, Journal Article)
• Copyright: © 2017 Japan Pediatric Society.

Chemical References

• Radiopharmaceuticals
• Technetium Tc 99m Dimercaptosuccinic Acid

Topics

• Cicatrix (diagnostic imaging, epidemiology, etiology)
• Female
• Fever (etiology)
• Follow-Up Studies
• Humans
• Incidence
• Infant
• Kidney (diagnostic imaging, pathology)
• Male
• Radionuclide Imaging
• Radiopharmaceuticals
• Recurrence
• Risk Assessment
• Technetium Tc 99m Dimercaptosuccinic Acid
• Urinary Tract Infections (complications, diagnostic imaging, epidemiology, pathology)