Practical approach to screen vesicoureteral reflux after a first urinary tract infection
Vesicoureteral reflux (VUR) is a common pediatric urologic disorder. After the first urinary tract infection (UTI), imaging studies are recommended, starting with a renal ultrasound (RUS). Voiding cystourethrography (VCUG) and dimercaptosuccinic acid (DMSA) scan are the other main radiologic studies...
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Published in | Indian journal of urology Vol. 30; no. 4; pp. 383 - 386 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
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India
Medknow Publications and Media Pvt. Ltd
01.10.2014
Medknow Publications & Media Pvt. Ltd Medknow Publications & Media Pvt Ltd Wolters Kluwer Medknow Publications |
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Abstract | Vesicoureteral reflux (VUR) is a common pediatric urologic disorder. After the first urinary tract infection (UTI), imaging studies are recommended, starting with a renal ultrasound (RUS). Voiding cystourethrography (VCUG) and dimercaptosuccinic acid (DMSA) scan are the other main radiologic studies used to detect VUR. We evaluated the use of RUS as a screening method for VUR in children below 2 years of age, in order to avoid unnecessary VCUG.
Medical records and imaging studies of infants (<2 years) who had their first UTI in a 6 year period were retrospectively reviewed. We evaluated the sensitivity, specificity, and negative predictive values of RUS and DMSA for diagnosing VUR.
Among 155 children (51% males) with their first UTI, 148 RUS were performed, 128 VCUG and 29 DMSA. VUR was detected in 21% patients; 14.5% low grade and 6.5% high grade. One hundred and twenty-one patients underwent both RUS and VCUG, 101 RUS were normal and 20 abnormal. Of the normal RUS 98% had no or low grade VUR. Among those with an abnormality on RUS 30% had high grade VUR (P < 0.001).
After the first UTI in infants (<2 years) RUS is a good screening method for VUR. Among such shildren with a normal RUS, we do not recommend VCUG or DMSA. In our opinion, VCUG should be performed only in patients with abnormal findings in RUS or in recurrent UTI. |
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AbstractList | Introduction: Vesicoureteral reflux (VUR) is a common pediatric urologic disorder. After the first urinary tract infection (UTI), imaging studies are recommended, starting with a renal ultrasound (RUS). Voiding cystourethrography (VCUG) and dimercaptosuccinic acid (DMSA) scan are the other main radiologic studies used to detect VUR. We evaluated the use of RUS as a screening method for VUR in children below 2 years of age, in order to avoid unnecessary VCUG. Materials and Methods: Medical records and imaging studies of infants (<2 years) who had their first UTI in a 6 year period were retrospectively reviewed. We evaluated the sensitivity, specificity, and negative predictive values of RUS and DMSA for diagnosing VUR. Results: Among 155 children (51% males) with their first UTI, 148 RUS were performed, 128 VCUG and 29 DMSA. VUR was detected in 21% patients; 14.5% low grade and 6.5% high grade. One hundred and twenty-one patients underwent both RUS and VCUG, 101 RUS were normal and 20 abnormal. Of the normal RUS 98% had no or low grade VUR. Among those with an abnormality on RUS 30% had high grade VUR (P = 0.001). Conclusions: After the first UTI in infants (<2 years) RUS is a good screening method for VUR. Among such shildren with a normal RUS, we do not recommend VCUG or DMSA. In our opinion, VCUG should be performed only in patients with abnormal findings in RUS or in recurrent UTI. Vesicoureteral reflux (VUR) is a common pediatric urologic disorder. After the first urinary tract infection (UTI), imaging studies are recommended, starting with a renal ultrasound (RUS). Voiding cystourethrography (VCUG) and dimercaptosuccinic acid (DMSA) scan are the other main radiologic studies used to detect VUR. We evaluated the use of RUS as a screening method for VUR in children below 2 years of age, in order to avoid unnecessary VCUG. Medical records and imaging studies of infants (<2 years) who had their first UTI in a 6 year period were retrospectively reviewed. We evaluated the sensitivity, specificity, and negative predictive values of RUS and DMSA for diagnosing VUR. Among 155 children (51% males) with their first UTI, 148 RUS were performed, 128 VCUG and 29 DMSA. VUR was detected in 21% patients; 14.5% low grade and 6.5% high grade. One hundred and twenty-one patients underwent both RUS and VCUG, 101 RUS were normal and 20 abnormal. Of the normal RUS 98% had no or low grade VUR. Among those with an abnormality on RUS 30% had high grade VUR (P < 0.001). After the first UTI in infants (<2 years) RUS is a good screening method for VUR. Among such shildren with a normal RUS, we do not recommend VCUG or DMSA. In our opinion, VCUG should be performed only in patients with abnormal findings in RUS or in recurrent UTI. INTRODUCTIONVesicoureteral reflux (VUR) is a common pediatric urologic disorder. After the first urinary tract infection (UTI), imaging studies are recommended, starting with a renal ultrasound (RUS). Voiding cystourethrography (VCUG) and dimercaptosuccinic acid (DMSA) scan are the other main radiologic studies used to detect VUR. We evaluated the use of RUS as a screening method for VUR in children below 2 years of age, in order to avoid unnecessary VCUG. MATERIALS AND METHODSMedical records and imaging studies of infants (<2 years) who had their first UTI in a 6 year period were retrospectively reviewed. We evaluated the sensitivity, specificity, and negative predictive values of RUS and DMSA for diagnosing VUR. RESULTSAmong 155 children (51% males) with their first UTI, 148 RUS were performed, 128 VCUG and 29 DMSA. VUR was detected in 21% patients; 14.5% low grade and 6.5% high grade. One hundred and twenty-one patients underwent both RUS and VCUG, 101 RUS were normal and 20 abnormal. Of the normal RUS 98% had no or low grade VUR. Among those with an abnormality on RUS 30% had high grade VUR (P < 0.001). CONCLUSIONSAfter the first UTI in infants (<2 years) RUS is a good screening method for VUR. Among such shildren with a normal RUS, we do not recommend VCUG or DMSA. In our opinion, VCUG should be performed only in patients with abnormal findings in RUS or in recurrent UTI. |
Audience | Academic |
Author | García, Begoña Santiago Luján, Esther Aleo Fuente, María Álvarez Costa, Talía Sainz Serrano, Marcelina Algar Alonso, Manuel Sosa |
AuthorAffiliation | Department of Pediatrics, Hospital Clínico San Carlos, Madrid, Spain |
AuthorAffiliation_xml | – name: Department of Pediatrics, Hospital Clínico San Carlos, Madrid, Spain |
Author_xml | – sequence: 1 givenname: María Álvarez surname: Fuente fullname: Fuente, María Álvarez organization: Department of Pediatrics, Hospital Clínico San Carlos, Madrid, Spain – sequence: 2 givenname: Talía Sainz surname: Costa fullname: Costa, Talía Sainz organization: Department of Pediatrics, Hospital Clínico San Carlos, Madrid, Spain – sequence: 3 givenname: Begoña Santiago surname: García fullname: García, Begoña Santiago organization: Department of Pediatrics, Hospital Clínico San Carlos, Madrid, Spain – sequence: 4 givenname: Marcelina Algar surname: Serrano fullname: Serrano, Marcelina Algar organization: Department of Pediatrics, Hospital Clínico San Carlos, Madrid, Spain – sequence: 5 givenname: Manuel Sosa surname: Alonso fullname: Alonso, Manuel Sosa organization: Department of Pediatrics, Hospital Clínico San Carlos, Madrid, Spain – sequence: 6 givenname: Esther Aleo surname: Luján fullname: Luján, Esther Aleo organization: Department of Pediatrics, Hospital Clínico San Carlos, Madrid, Spain |
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Cites_doi | 10.1111/j.1651-2227.1999.tb01323.x |
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Keywords | voiding cystourethrography Dimercaptosuccinic acid scan vesicoureteral reflux urinary tract infection |
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Snippet | Vesicoureteral reflux (VUR) is a common pediatric urologic disorder. After the first urinary tract infection (UTI), imaging studies are recommended, starting... Introduction: Vesicoureteral reflux (VUR) is a common pediatric urologic disorder. After the first urinary tract infection (UTI), imaging studies are... INTRODUCTIONVesicoureteral reflux (VUR) is a common pediatric urologic disorder. After the first urinary tract infection (UTI), imaging studies are... |
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StartPage | 383 |
SubjectTerms | Diagnosis Dimercaptosuccinic acid scan Original Pediatrics urinary tract infection Urinary tract infections vesicoureteral reflux voiding cystourethrography |
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Title | Practical approach to screen vesicoureteral reflux after a first urinary tract infection |
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