The sensitivity of ultrasonography in detecting renal cortical defects in pyelonephritic patients with or without vesicoureteral reflux
Journal of Pediatric Nephrology,
Vol. 1 No. 1 (2013),
24 Mordad 2013
,
Page 28-31
https://doi.org/10.22037/jpn.v1i1.4341
Abstract
How to Cite This Article: Mohkam M, Mahdavi C, Arad B, et al. The sensitivity of ultrasonography in detecting renal cortical defects in pyelonephritic patients with or without vesicoureteral reflux. J Ped. Nephrology 2013 July;1(1):28-31.
Introduction: The presence of renal scarring has been documented in 5% to 15% of febrile urinary tract infections. The main aim of this study was to compare the value of renal ultrasonography and cortical scintigraphy with technetium-99m dimercaptosuccinic acid (DMSA) in detecting renal cortical defects in acute pyelonephritis.
Materials and Methods: Between June 2003 and February 2012 a prospectivecohort study of patients aged 1 month to 14 years of age was conducted. Pediatric patients with documented urinary tract infections were evaluated with renal ultrasonography, voiding cystoureterography (VCUG) and DMSA scintigraphy. Statistical test was two-tailed and was considered significant when P≤ 0.05.
Results: The results of DMSA scans showed 70.2% of cases as being abnormal. Renal ultrasonographies were reported to be normal in 72.45 and showed mild hydronephrosis in 37.7% of cases, moderate to severe hydronephrosis in 40.62%, stone formation in 13.66% and scar formation or decreased cortical thickness in 8.2%. There was a significant difference in ultrasonography reports between patients with normal and abnormal DMSA scans (P< 0.012) but there was no significant difference in detection of scar formation between DMSA scan results and those of ultrasonography in our patients. Among patients with severe abnormalities on DMSA scintigraphy the percent of cases with vesicoureteral reflux was significantly higher than those with normal scans or mild to moderate changes on DMSA scintigraphy. (46.3% vs 26.9%).
Conclusions: We concluded that ultrasonography is a sensitive method for detection of renal cortical defects and ultrasonography can also predict the presence of vesicoureteral reflux in pyelonephritic patients.
Keywords: Ultrasonography; Pyelonephritis; Pediatrics; Vesico-ureteral Reflux; Technetium Tc 99m dimercaptosuccinic acid; Radionuclide imaging
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References
Jakobsson B, Esbjorner E, Hansson S. Minimum incidence and diagnostic rate of first urinary tract infection. Pediatrics 1999;104:222-6.
Stark H. Urinary tract infections in girls: the cost-effectiveness of currently recommended investigative routines. Pediatr Nephrol 1997;11:174-7.
Larcombe J. Clinical evidence: urinary tract infection in children. BMJ 1999;319:1173-5.
Rosenberg AR, Rossleigh MA, Brydon MP. Evaluation of acute urinary tract infection in children dimercaptosuccinic acid scintigraphy: a prospective study. J Urol 1992;148:1746-9.
Merrick MV, Notghi A, Chalmers N, Wilkinson AG, Uttley WS. Long-term follow up to determine the prognostic value of imaging after urinary tract infections. Part 2: scarring. Arch Dis Child 1995;72:393–6.
Temiz Y, Tarcan T, Onol FF, Alpay H, Simsek F. The efficacy of Tc99m dimercaptosuccinic acid (Tc-DMSA) scintigraphy and ultrasonography in detecting renal scars in children with primary vesicoureteral reflux (VUR). Int Urol Nephrol 2006;38(1):149-52.
Lavocat MP, Granjon D, Allard D, Gay C. Imaging of pyelonephritis. Pediatr Radiol 1997;27(2):159-165.
Christian M T, McColl J H, MacKenzie J R, Beattie T J. Risk assessment of renal cortical scarring with urinary tract infection by clinical features and ultrasonography. Arch Dis Child 2000; 82:376–380.
Barry BP, Hall N, Cornford E, Broderick NJ, Somers JM, Rose DH. Improved ultrasound detection of renal scarring in children following urinary tract infection. Clin Radiol 1998;53:747–51.
Mohkam M, Maham S, Khatami A et al. Kidney Ultrasonography and Dimercaptosuccinic Acid Scans for Revealing Vesicoureteral Reflux in Children With Pyelonephritis: A 7-Year Prospective Cohort Study of 1500 Pyelonephritic Patients and 2986 Renal Units. Nephro-Urol Mon 2012;4(1):350-355.
Mohkam M, Maham S, Rahmani A. et al. Technetium Tc 99m Dimercaptosuccinic Acid Renal Scintigraphy in Children With Acute Pyelonephritis IJKD 2010;4:297-301.
Almeida HN, Ribeiro M, Colarinha J, Santos JF, Rosa FC. Imaging methods in the study of urinary tract infections in children. Acta Med Port 1994;7 Suppl 1:15-20.
Stokland E, Hellström M, Jakobsson B, Sixt R. Imaging of renal scarring. Acta Paediatr Suppl. 1999;88(431):13-21.
Moorthy I, Wheat D, Gordon I. Ultrasonography in the evaluation of renal scarring using DMSA scan as the gold standard. Pediatr Nephrol 2004;19(2):153-6.
Sinha MD, Gibson P, Kane T, Lewis MA. Accuracy of ultrasonic detection of renal scarring in different centers using DMSA as the gold standard. Nephrol Dial Transplant 2007;22(8):2213-6.
Bjorgvinsson E, Majd M, Egglil KD. Diagnosis of Acute Pyelonephritis in Children: Comparison of Sonography and 99mTc-DMSA Scintigraphy. AJR 1991;157:539-543.
Monsour M, Azmy AF, MacKenzie JR. Renal scarring secondary to vesicoureteric reflux. Critical assessment and new grading. Br J Urol 1987;60(4):320-4.
Scherz HC, Downs TM, Caesar R. The selective use of dimercaptosuccinic acid renal scans in children with vesicoureteral reflux. J Urol 1994; 152(2):628-31.
Roebuck DJ, Howard RG, Metreweli C. How sensitive is ultrasound in the detection of renal scars? Br J Radiol 1999;72(856):345-8.
Wang YT, Chiu NT, Chen MJ, Huang JJ, Chou HH, Chiou YY. Correlation of renal ultrasonographic findings with inflammatory volume from dimercaptosuccinic acid renal scans in children with acute pyelonephritis. J Urol 2005;173(1):190-4.
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