ESPN 51th Annual Meeting

ESPN 2018


 
THE “TOP-DOWN” APPROACH FOR THE EVALUATION OF CHILDREN WITH FEBRILE URINARY TRACT INFECTION; SINGLE CENTER EXPERIENCE
HULYA NALCACIOGLU 1 OZGUR CAGLAR 2 SIBEL YEL 1 FUNDA BASTUG 1

1- KAYSERI TRAINING AND RESEARCH HOSPITAL, DEPARTMENT OF PEDIATRIC NEPHROLOGY, KAYSERI, TURKEY
2- KAYSERI TRAINING AND RESEARCH HOSPITAL, DEPARTMENT OF PEDIATRIC SURGERY, KAYSERI, TURKEY
 
Introduction:

In children with febrile urinary tract infections (UTI), there are different sights on the essential and timing of DMSA scintigraphy or other imaging modalities to define vesicoureteral reflux (VUR) and no ideal method has been identified. There are approaches from “top-down” or “bottom-up” according to the order. This study aimed to reevaluate the efficacy of 99mTc-DMSA renal scans for voiding cystourethrography (VCUG) in children with febrile UTI.

Material and methods:

Between July 2015 and December 2016, medical records of 112 patients who applied with febrile UTI were retrospectively reviewed. The demographic information of the patients, the number of urinary tract infections, follow-up imaging (Ultrasonography, DMSA renal scans and VCUG) datas were reviewed.

Results:

Of the 112 patients, 82 patients (73.2%) were female, 30 were male (26.8%) and the mean age was 7.04 ± 3.94 years. Recurrent febril UTI was detected in 65 patients (58%). Of the 68 patients (60.7%) had abnormal Urinary System Ultrasonography, 74 patients (66.1%) had abnormal DMSA scans. VUR was detected in 63 patients (56.3%). VUR was present in 49 (66.2%) of 74 patients with scarring in DMSA and reflux was detected in 14 (38.8%) of 38 patients with normal DMSA scans. Significant (kappa: 0.274 / p = 0.003) agreement was found between DMSA and reflux results. Sensitivity was 77.8%, positive predictive value was 66.2%, specificity was 49% and negative predictive value was 63.2%.

Conclusions:

 We found a significant association between DMSA and reflux results in our study. DMSA could play an important role in selecting children with UTI/VUR who would benefit from early intervention. More data are needed for evidence-based guidelines.