Childhood Kidney Diseases

Korean Society of Pediatric Nephrology (대한소아신장학회)
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Clinical Efficacy of a Top-down Approach for Children with a First Febrile Urinary Tract Infection

  • Jang, Kyung Mi (Department of Pediatrics, College of Medicine, Yeungnam University) ;
  • Lim, Myung Hee (Department of Pediatrics, College of Medicine, Yeungnam University) ;
  • Park, Yong Hoon (Department of Pediatrics, College of Medicine, Yeungnam University) ;
  • Kim, Saeyoon (Department of Pediatrics, College of Medicine, Yeungnam University)
  • Received : 2017.08.31
  • Accepted : 2017.10.02
  • Published : 2017.10.30
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Abstract

Purpose: The aim of this study was to determine the clinical characteristics, frequency of renal abnormalities and benefits of a top-down approach in children with their first febrile urinary tract infection (UTI). Methods: We reviewed 308 patients retrospectively who were admitted to Yeungnam University Hospital and were treated for their first febrile UTI from February 2006 to December 2013. We performed a comparative analysis of laboratory findings and results of imaging techniques including a Tc-99m dimercaptosuccinic acid (DMSA) renal scan. Results: Among the patients, 69% (213/308) were males, and 90% (277/308) had their first UTI episode during infancy. A DMSA renal scan was performed on all patients, and showed positive findings in 60% (184/308) of cases. Laboratory indices of inflammation were significantly higher in the DMSA-positive group (P< 0.05). There was a statistically significant difference in the age distribution between the two groups. In the DMSA-positive group, 165 patients underwent voiding cystourethrography (VCUG), and 58 (35%) cases demonstrated vesicoureteral reflux. In total, 110 patients in the DMSA-positive group, underwent repeat scanning at 6 months; 33 children (30%) demonstrated static scarring, but 77 (70%) had improved completely. The concordance of the ultrasonography (US) and VCUG was low. Older patients had more renal scarring. Conclusion: DMSA is a sensitive method for assessing the severity of inflammation and kidney injury. However, the ability of US to predict renal parenchymal damage was limited. A top-down approach in children with their first febrile UTI showed significant value.

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References

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