Imaging studies in urinary tract infection in Libyan children
DOI:
https://doi.org/10.54361/AlmurabetKeywords:
urinary tract infection, renal ultrasound, voiding cystourethrography, vesicouretral reflux, 99m technetiumdimercaptosuccunic acid scan, renal scarringAbstract
Acute pylonephritis is a common occurrence and results in irreversible renal damage which may lead later in life to arterial hypertension and renal insufficiency. This article is to review of the current role and controversies in imaging revealed VUR in 27.4% (14 of 51) patient with normal RUS. RUS has 22% sensitivity and 68% specificity in detecting VUR and 67% sensitivity and 47.7% specificity in detecting renal the kidneys to evaluate patients with acute pylonephritis. Patients and methods: retrospective study including 180 patients with acute pylonephritis (132 girls and 48 boys) mean age four years were uroradiologicalimages had been performed for them. Renal ultrasound and RUS were obtained at the time of diagnosis, voiding cysto urethrography (VCUG) was performed for 178 patients 4 - 6 weeks later, 99m technetiumdimer-captosuccuinic acid scan (DMSA) was performed for 155 patients 4 - 6 months after the infection. Results: RUS was abnormal in 190 renal units (51%) renal scaring was detected only in 9 (2.5%) kidneys by RUS, 37% (66 of 178) patients who underwent voidingcystourethrogram had abnormal VCUG. VCUG showed vesicoureteral reflux in 63 patients (35%), VCUG abnormalities whatever it is with positive predictive value of 79.8% and negative predictive value of 32%. VUR was bilateral in 53%, right side in 22%, left side in 25% of patients. Regarding the grade of VUR, it was grade I - II in 11%, grade III in 22%, and grade V - IV in (67%), 30% of patient with VUR were older than 5 years. DMSA revealed renal scarring in 74% (115 of 155) of patients. Renal scarring was seen in 86% of refluxing kidneys (risk factor 1.3, p = 0.005) and seen in 95% of kidneys with grade (IV - V) vesicoureteral reflux. Conclusion: renal ultrasound remains necessary in order to detect urinary tract abnormalities although it is not reliable to confirm the presence or absence of VUR. Significant incidence of VUR in children with UTI, VCUG is the golden standard in detecting VUR. Renal scarring is commonly seen and it was significantly correlated with the presence of VUR and the risk of scarring greatly increased with severe reflux.
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Copyright (c) 2014 Fathia A. Almurabet, Mohamed A. Altruki, kheria O. Almamouri (Author)
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