ROLE OF VARIOUS IMAGING MODALITIES AFTER A FIRST FEBRILE URINARY TRACT INFECTION IN YOUNG CHILDREN
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 11
Abstract
BACKGROUND UTI in the paediatric population is well-recognised as the cause of acute morbidity and chronic medical conditions such as hypertension and renal insufficiency in adulthood.1 The goal of imaging studies in children with UTI is to identify anatomic abnormalities that predispose to infection, determine whether there is active renal involvement and to assess whether renal function is normal or at risk. Aims and Objectives- To measure the incidence of renal scarring in patients admitted with first febrile UTI. To list renal image findings in patients with first febrile UTI, 1 - 36 months of age. MATERIALS AND METHODS A total of 108 patients, 1 - 36 months of age, coming with first febrile UTI, either admitted or on an outpatient department basis during one and a half years, who satisfy the inclusion criteria were studied. Renal scanning with technetium-99m labeled dimercaptosuccinic acid and renal ultrasonography were performed in the acute phase to determine the presence or absence of acute pyelonephritis and anatomical abnormalities, respectively. Contrast voiding cystourethrography was performed approximately one month after diagnosis in those with abnormal ultrasound or abnormal DMSA. Technetium-99m labeled dimercaptosuccinic acid renal scanning was repeated six months later to determine the incidence and severity of renal scarring. Age groups, sex, VCUG, renal ultrasonography and DMSA renal scintigraphy results were analysed. RESULTS Out of 108 patients, RBUS was normal in 63 (58%) and abnormal in 45 (42%). Sonogram showed changes consistent with acute pyelonephritis in 27.7% (30/108) of the whole group and in only 57.7% (30/52) of the patients with scintigraphically documented acute pyelonephritis. DMSA was suggestive of acute pyelonephritis in 52 (48%) patients in acute stage and of renal scarring in 22 (20%) at 6 months. All patients who had scarring at 6 months had abnormal initial scan. Out of 69 patients with abnormal ultrasonography or scanning who were subjected to VCUG, 39 had vesicoureteral reflux (56.5%). Renal scarring was more likely to occur in children with documented VUR than those without VUR (17/39 vs. 5/30). Among the patients with VUR, scarring was seen more likely in patients with higher grades of VUR. CONCLUSION The renal ultrasound is of limited value in febrile UTI, especially at places where DMSA scanning is available. The use of DMSA during acute illness identifies patients with acute pyelonephritis who are at risk of development of renal scarring later in life. VCUG may demonstrate a relationship between VUR and renal inflammation and identify high-risk group for development of renal scarring.
Authors and Affiliations
Khalid Mohi-uddin Kawoosa, Syed Wajid Ali, Syed Heena Kubran
Keywords
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- EP ID EP411655
- DOI 10.14260/jemds/2018/319
- Views 81
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