Abstract
Background: UTIs are common infections that happen when bacteria, often from the skin or rectum, enter the urethra and infect the urinary tract. The infections can affect several parts of the urinary tract, but the most common type is a bladder infection (cystitis). Dimercaptosuccinic acid (DMSA) scintigraphy is the gold standard in the evaluation of renal parenchymal defects and is widely used in the pediatric population. As more recent ultrasound equipment was purchased at our tertiary pediatric center, our objective was to evaluate if renal ultrasound (US) results are equivalent or sufficient when compared to DMSA scintigraphy in the assessment of renal anomalies.
Aim and Objective: To find out whether renal ultrasonography or dimercaptosuccinic acid renal scintigraphy can be used as the first imaging modality after a case of febrile Urinary tract infection in children less than 5 years of age.
Methods: this prospective observational study was conducted in the Pediatric department of KMCH, Coimbatore from MAY 2019 – DECEMBER 2019. . 90 children with culture-proven febrile Urinary tract infection from the department of pediatrics KMCH will be included in the study to compare technetium-99m DimercaptoSuccinic Acid renal cortical scintigraphy and Ultrasound KUB in detecting renal parenchymal defects in Febrile Urinary tract infection in children.
Results: In our study out of 90 children 53.3% were males and 46.7% were female. All children included in this study were significant Urine Culture Positive. The most common organism isolated in urine culture was E. coli followed by Klebsiella. In our study, the sensitivity and specificity of USG KUB in detecting Renal parenchymal abnormalities in comparison with DMSA is 12 % and 95.4 % respectively. And the positive predictive value of USGKUB is 50% and the negative predictive value is 73.8 % in detecting parenchymal defects in children when compared to DMSA.
Conclusion: It is observed from our study that although ultrasonography has a good specificity in the detection of renal parenchymal defects when compared with DMSA, it has low sensitivity, positive predictive value, and negative predictive value. Thus we conclude that at present Ultrasonography cannot be substituted for DMSA in identifying renal parenchymal defects in children with Febrile UTI. Dimercaptosuccinic acid scan done at presentation identifies children with acute pyelonephritis and at six months later identify those children with scarring
Keywords: Urinary Tract Infection, Ultrasound Kidney Ureter Bladder, Di Mercapto Succinic Acid renal scintigraphy, Micturating Cysto Urethrogram, Escherichia Coli.
References
- Ayazi P, Mahyar A, Noroozian E, Esmailzadehha N, Barikani Comparison of renal ultrasonography and dimercaptosuccinic acid renal scintigraphyin febrile urinary tract infection. Le infezioniin Medicina.2017: n.4,323-329.
- Barry BP, Hall N, Cornford E, et Improved ultrasound detection of renal scarring in children following urinary tract infection. ClinRadiol.1998;53:747–51
- Bhatnagar V, Mitra D, Agarwala S.,et al. The role of DMSA scans in the evaluation of the correlation between urinary tract infection, vesicoureteric reflux, and renal scarring. PediatrSurgInt18, 128–134 (2002)
- Bjorgvinsson E, Majd M, Eggli KD. Diagnosis of Acute Pyelonephritis in children: Comparision of sonography and 99m-Tc DMSA scintigraphy. AJR Am J Roentgenol.1991:157(3),539-543.
- Das R N, Chandrashekhar TS, Joshi H S, Gurung M, Shrestha N, Shivananda PG. Frequency and susceptibility profile ofpathogens causing urinary tract infections at a tertiary care hospital in western Nepal. Singapore M J2006;47(4):281-285.
- Dharmalingam A, Pawar SU, Parelkar SV, Shetye SS, Ghorpade MK, Clive GH, et Tc-99m ethylenediamine and Tc-99m dimercaptosuccinic acid scintigraphy-comparison of the two for detection of scarring and differential cortical function. Indian J Nucl Med 2017;32:93-7.
- HitzelA, Liard A, Vera P, Manrique A, Menard J, Dacher J. Color and Power Doppler Sonography Versus DMSA Scintigraphyin Acute Pyelonephritis and prediction of renal scarring. J Nucl Med 2002;43(1):27-32.
- HobermanA, Charron M, Hickey RW, et Imaging studies after a first febrile urinary tract infection in young children. N Engl J Med. 2003;348(3):195–202.
- Jakobsson B, Nolstedt L, Svensson L, Soderlundh S, Berg U. 99m Technetium dimercaptosuccinic acid scan in the diagnosis of acute pyelonephritis in children: relation to clinical and radiological findings. PediatrNephrol1992;6:328-34.
- Jepson RG, Williams G, Craig JC. Cranberries for preventing urinary tract infections. Sao Paulo Med J . 2013;131:363.
- Kliegman RM, St Geme III JW, Blum NJ, Tasker RC, Shah SS, Wilson KM. Nelson textbook of pediatrics. 21 ed. Philadelphia: Elsevier; 2020, pp2789-95.
- Marceau-Grimard M, Marion A, Côté C, Bolduc S, Katherine Moore MD, Dimercaptosuccinic acid scintigraphy ultrasound for renal parenchymal defects in children. Canadian urological association journal.2017:11,260-264.
- Montini G, TullusK, Hewitt I. Febrile urinary tract infections in N Engl J Med. 2011;365:239–50.
- Montini G, Zucchetta P, Tomasi L, et al. Value of Imaging Studies After a First Febrile Urinary Tract Infection in Young Children: Data From Italian Renal InfectionStudy
- Moorthy I, Wheat D, Gordon I. Ultrasonography in the evaluation of renal scarring using DMSA scan as the gold standard. PediatrNephrol2004;19(2):153e6.
- Nammalwar BR, Vijayakumar M, Sankar J, Ramnath B, Prahlad N. Evaluation of theuse of DMSA in culture-positive UTI and culture-negative acute pyelonephritis. Indian Pediatr. 2005;42:691-6.
- Patel K, Charron M, Hoberman A, Brown ML, Rogers KD. Intra observer and inter-observer variability in the interpretation of DMSA scans using a set of standardized criteria. PediatrRadiol 1993;23:506-9.
- Peters CA, Skoog SJ, Arant BS Jr, et Summary of the AUA guideline on management of primary vesicoureteral reflux in children. J Urol . 2010;184:1134–1144.
- Rajiv Sinha, Devdeep Mukherjee, Jayati Sengupta, Subasasis Saha, and Susmitha Banerjee. The yield of Imaging Performed as per Indian Society of Pediatric Nephrology Guidelines in Children with Urinary Tract Infection. Indian Pediatr.2017;54:749–751.
- Roebuck D J, Howard R G, Metreweli. How sensitive is ultrasound in the detection of renal scars? BJR 1999;856(72):345-348.
Corresponding Author
Dr K Rajendran
Professor & Head, Department of Paediatrics & Neonatology, Kovai Medical Centre, and Hospital, Coimbatore, Tamil Nadu India
DOI: https://dx.doi.org/10.18535/jmscr/v9i2.37
