Browse > Article
http://dx.doi.org/10.3345/kjp.2010.53.222

The relationships between clinical variables and renal parenchymal disease in pediatric clinically suspected urinary tract infection  

Byun, Jung Lim (Department of Pediatrics, Konkuk University School of Medicine)
Lee, Sang Taek (Department of Pediatrics, Konkuk University School of Medicine)
Chung, Sochung (Department of Pediatrics, Konkuk University School of Medicine)
Kim, Kyo Sun (Department of Pediatrics, Konkuk University School of Medicine)
Publication Information
Clinical and Experimental Pediatrics / v.53, no.2, 2010 , pp. 222-227 More about this Journal
Abstract
Purpose : To evaluate the significance of clinical signs and laboratory findings as predictors of renal parenchymal lesions and vesicoureteral reflux (VUR) in childhood urinary tract infection (UTI). Methods : From July 2005 to July 2008, 180 patients admitted with a first febrile UTI at the Pediatric Department of Konkuk University Hospital were included in this study. The following were the clinical variables: leukocytosis, elevated C-reactive protein (CRP), positive urine nitrite, positive urine culture, and fever duration both before and after treatment. We evaluated the relationships between clinical variables and dimercaptosuccinic acid (DMSA) scan and voiding cystourethrography (VCUG) results. Results : VCUG was performed in 148 patients; of them, 37 (25.0%) had VUR: 18 (12.2%) had low-grade (I-II) VUR, and 19 (10.5%) had high-grade (III-V) VUR. Of the 95 patients who underwent DMSA scanning, 29 (30.5%) had cortical defects, of which 21 (63.6%) had VUR: 10 (30.3%), low-grade (I-II) VUR; and 11 (33.3%), high-grade VUR. Of the 57 patients who were normal on DMSA scan, 8 (14.0%) had low-grade VUR and 6 (10.5%) had high-grade VUR. The sensitivity, specificity, and positive and negative predictive values of the DMSA scan in predicting high-grade VUR were 64.7%, 69.9%, 33.3%, and 89.5%, respectively. Leukocytosis, elevated CRP, and prolonged fever ($36{\geq}$ hours) after treatment were significantly correlated with the cortical defects on DMSA scans and high-grade VUR. Conclusion : Clinical signs, including prolonged fever after treatment, elevated CRP, and leukocytosis, are positive predictors of acute pyelonephritis and high-grade VUR.
Keywords
Urinary tract infection; Vesicoureteral reflux; Tc-99m Dimercaptosuccinic acid; Child;
Citations & Related Records
Times Cited By KSCI : 2  (Citation Analysis)
연도 인용수 순위
1 Nammalwar BR, Vijayakumar M, Sankar J, Ramnath B, Prahlad N. Evaluation of the use of DMSA in culture positive UTI and culture negative acute pyelonephritis. Indian Pediatr 2005;42:691-6   PUBMED   ScienceOn
2 Camacho V, Estorch M, Fraga G, Mena E, Fuertes J, Hern$\ndez MA et al. DMSA study performed during febrile urinary tract infection: a predictor of patient outcome? Eur J Nucl Med Mol Imaging 2004;3:862-6   DOI   ScienceOn
3 Lebowitz RL, Olbing H, Parkkulainen KV, Smellie JM, Tamminen-M$\"{o}$bius TE. International system of radiographic grading of vesicoureteric reflux. International reflux study in children. Pediatr Radiol 1985;15:105-9   DOI   ScienceOn
4 Silva JM, Diniz JS, Lima EM, Vergara RM, Oliveira EA. Predictive factors of resolution of primary vesico-ureteric reflux: a multivariate analysis. BJU Int 2006;97:1063-8   DOI   ScienceOn
5 Hoberman A, Charron M, Hickey RW, Baskin M, Kearney DH, Wald ER. Imaging studies after a first febrile urinary tract infection in young children. N Engl J Med 2003;348:195-202   DOI   ScienceOn
6 Jakobsson B, Berg U, Svensson L. Renal scarring after acute pyelonephritis. Arch Dis Child 1994;70:111-5   DOI   ScienceOn
7 Bisset GS 3rd, Strife JL, Dunbar JS. Urography and voiding cystourethrograpy: Findings in girls with urinary tract infection. AJR Am J Roentgenol 1987;148:479-82   DOI   PUBMED   ScienceOn
8 Gleeson FV, Gordon I. Imaging in urinary tract infection. Arch Dis Child 1991;66:1282-3   DOI   ScienceOn
9 Han HJ, Kim JH, Lee HS, Lee IS. The significance of renal imaging studies in the diagnosis of acute pyelonephritis. J Korean Soc Pediatr Nephrol 2007;2:212-9
10 Stokland E, Hellström M, Jacobsson B, Jodal U, Lundgren P, Sixt R. Early 99-mTc dimercaptosuccinic acid (DMSA) scintigraphy in symptomatic first-time urinary tract infection. Acta Paediatr 1996;85:430-6   DOI   ScienceOn
11 Downs SM. Technical report: urinary tract infections in febrile infants and young children. The Urinary Tract Subcommittee of the American Academy of Pediatrics Committee on Quality Improvement. Pediatrics 1999;103:e54   DOI   PUBMED   ScienceOn
12 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 1: Reflux. Arch Dis Child 1995;72:388-92   DOI   ScienceOn
13 Rushton HG. Urinary tract infections in children: epidemiology, evaluation and management. Pediatr Clin North Am 1997;44:1133-69   DOI   PUBMED   ScienceOn
14 Jung JI, Lim DH, Yim HE, Park MS, Yoo KH, Hong YS et al. Fever duration and renal scar in pediatric urinary tract infection. J Korean Soc Pediatr Nephrol 2008;12:70-7   DOI   ScienceOn
15 Eggli DF, Tulchinsky M. Scintigraphic evaluation of pediatric urinary tract infection. Semin Nucl Med 1993;3:199-218
16 Wennerström M , Hansson S, Jodal U, Stokland E. Primary and acquired renal scarring in boys and girls with urinary tract infection. J Pediatr 2000;136:30-4   DOI   ScienceOn
17 Keren R. Imaging and treatment strategies for children after first urinary tract infect infection. Curr Opin in Pediatr 2007;19:705-10   DOI   PUBMED   ScienceOn
18 Jung SW, Jung KH, Kim MH, Lee JE, Hong YJ, Son BK. Factors associated with renal scarring in children with a first episode of febrile urinary tract infection. J Korean Soc Pediatr Nephrol 2005;9:56-63   과학기술학회마을   ScienceOn
19 Piepsz A, Colarinha P, Gordon I, Hahn K, Olilvier P, Roca I, et al. Guidelines for 99m Tc-DMSA scintigraphy in children. Eur J Nucl Med 2001;28:37-41   ScienceOn
20 Keays MA, Guerra LA, Mihill J, Raju G, Al-Ashleri N, Geier P, et al. Reliability assessment of society for fetal urology ultrasound grading system for hydronephrosis. J Urol 2008;180:1680-2   DOI   ScienceOn
21 Fern$\ndez-Men$\ndez JM, M$\laga S, Matesanz JL, Sol$\s G, Alonso S, P$\rez-M$\ndez C. Risk factors in the development of early technetium-99m dimercaptosuccinic acid renal scintigraphy lesions during first urinary tract infection in children. Acta Paediatr 2003;92:21-6   DOI   PUBMED
22 Jacobson SH, EklöfE O, Eriksson CG, Lins LE, Tidgren B, Winberg J. Development of hypertension and uraemia after pyelonephritis in childhood: 27 year follow up. BMJ 1989;299:703-6   DOI   ScienceOn
23 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;72:393-96   DOI   ScienceOn
24 McKerrow W, Davidson-Lamb N, Jones PF. Urinary tract infection in children. Br Med J(Clin Res Ed) 1984;289:299-303   DOI   PUBMED