The role of late dimercaptosuccinic acid (DMSA) scan and renal ultrasonography for vesicoureteral reflux in older children with first febril urinary tract infection

INTRODUCTION: Introduction
Vesicoureteral reflux (VUR) is an important risk factor for urinary tract infection (UTI). We aimed to investigate the relationships between VUR and ultrasound with late dimercaptosuccinic acid (DMSA) scan findings in children older than two years with the first febril UTI (FUTI).



METHODS: The data from the patients with the first FUTI were retrospectively analysed. A late DMSA scan was performed at least 6 months after an acute FUTI. The late DMSA scan were graded as mild (focal defect in uptake), moderate (uptake of renal radionuclide from 20 to 40%), and severe (shrunken kidney with uptake less than 20%). Micturiting cystourethrography was performed at 3 to 6 weeks after FUTI.
RESULTS:
The records of 220 patients (61 mild VUR, 60 severe VUR, 99 without VUR) were reviewed. An abnormal US was more common in patients with VUR than those of without VUR (p=0.009). Abnormal US had a sensitivity of 79.34% for VUR and 81.67% for severe VUR. Negative predictive value of renal US for severe VUR was 91.13%. The frequency of renal scarring was higher in the patients with VUR than those of without VUR (102/44, p=0.001). a logistic regression analysis showed significant associations between abnormal US and VUR or severe VUR (p=0.019, p=0.011, respectively). Renal scarring had a sensitivity of 84.3% for VUR, 91.67% for severe VUR.

DISCUSSION AND CONCLUSION: The late DMSA scan findings could predict the presence and grade of VUR in older children with the first FUTI. Normal renal US could predict the absence of severe VUR.