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Permanent renal parenchymal defects after febrile UTI are closely associated with vesicoureteric reflux

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Abstract

The finding of scintigraphic renal defects in children with febrile urinary tract infection (UTI) even in the absence of vesicoureteric reflux (VUR) has led to the conclusion that VUR is a weak predictor of renal defects in these patients. We used isotopic cystography (IC) for diagnosis of VUR in children with febrile UTI. Dimercaptosuccinic acid renal scintigraphy was performed 6 months after cure of the last UTI. Renal defects were defined by the finding of focal defects of radionuclide uptake and/or by a split renal function <43%. The study included 206 children with primary VUR and 77 without VUR. Among the subjects with and without VUR, respectively, renal defects were found in 40 and 6% (p=0.0001), focal uptake defects in 33 and 5% (p=0.0001) and split renal function <43% in 26 and 5% (p=0.0001). Permanent renal defects in children with febrile UTI are closely associated with VUR. The possibility that a child will have permanent renal defects can reasonably be ruled out on the basis of the absence of VUR by IC.

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References

  1. Lin DS, Huang SH, Lin CC, Tung YC, Huang TT, Chiu NC, Koa HA, Hung HY, Hsu CH, Hsieh WS, Yang DI, Huang FY (2000) Urinary tract infection in febrile infants younger than eight weeks of age. Pediatrics 105:E20

    Article  PubMed  CAS  Google Scholar 

  2. Jacobson SH, Hansson S, Jakobsson B (1999) Vesicoureteric reflux: occurrence and long-term risks. Acta Paediatr Suppl 43:22–30

    Article  Google Scholar 

  3. Patzer L, Seeman T, Luck C, Wuhl E, Janda J, Misselwitz J (2003) Day-and night-time blood pressure elevation in children with higher grades of renal scarring. J Pediatr 142:117–122

    Article  PubMed  Google Scholar 

  4. McGladdery SJ, Aparicio S, Verrier-Jones K, Roberts R, Sacks SH (1992) Outcome of pregnancy in an Oxford-Cardiff cohort of women with previous bacteriuria. Q J Med 83:533–539

    PubMed  CAS  Google Scholar 

  5. Goldraich NP, Ramos AL, Goldraich IH (1989) Urography versus DMSA scan in children with vesicoureteric reflux. Pediatr Nephrol 3:1–5

    Article  PubMed  CAS  Google Scholar 

  6. Jakobsson B, Svensson L (1997) Transient pyelonephritic changes on 99mTechnetium-dimercaptosuccinic acid scan for at least 5 months after infection. Acta Paediatr 86:803–807

    Article  PubMed  CAS  Google Scholar 

  7. Gordon I, Barkovics M, Pindoria S, Cole TJ, Woolf AS (2003) Primary vesicoureteric reflux as a predictor of renal damage in children hospitalized with urinary tract infection: a systematic review and meta-analysis. J Am Soc Nephrol 14:739–744

    Article  PubMed  Google Scholar 

  8. Paltiel HJ, Rupic RC, Kiruluta HG (1992) Enhanced detection of vesicoureteral reflux in infants and children with use of cyclic voiding cystourethrography. Radiology 184:753–755

    PubMed  CAS  Google Scholar 

  9. Polito C, Moggio G, La Manna A, Cioce F, Cappabianca S, Di Toro R (2000) Cyclic voiding cystourethrography in the diagnosis of occult vesicoureteric reflux in infants and children. Pediatr Nephrol 14:39–41

    Article  PubMed  CAS  Google Scholar 

  10. Polito C, Rambaldi PF, La Manna A, Mansi PL, Di Toro R (2000) Enhanced detection of vesicoureteric reflux with isotopic cystography. Pediatr Nephrol 14:827–830

    Article  PubMed  CAS  Google Scholar 

  11. Nasrallah PF, Nara S, Crawford J (1982) Clinical applications of nuclear cystography. J Urol 128:550–553

    PubMed  CAS  Google Scholar 

  12. Fretzaias A, Karpathios T, Dimitriou P, Nicolaidou P, Matsaniotis N (1984) Grading of vesicoureteral reflux by radionuclide cystography. Pediatr Radiol 14:148–150

    Article  PubMed  Google Scholar 

  13. Kogan SJ, Sigler L, Levitt SB, Reda EF, Weiss R, Greifer I (1986) Elusive vesicoureteral reflux in children with normal contrast cystograms. J Urol 136:325–328

    PubMed  CAS  Google Scholar 

  14. Saraga M, Stanicic A, Markovic V (1996) The role of direct radionuclide cystography in evaluation of vesicoureteral reflux. Scand J Urol Nephrol 30:367–371

    Article  PubMed  CAS  Google Scholar 

  15. Poli-Merol ML, Francois S, Pfliger F, Lefebvre F, Roussel B, Liehn JC, Daoud S (1998) Interest of direct radionuclide cystography in repeated urinary tract infection exploration in childhood. Eur J Pediatr Surg 8:339–342

    Article  PubMed  CAS  Google Scholar 

  16. Schwartz GJ, Brion LP, Spitzer A (1987) The use of plasma creatinine concentration for estimating glomerular filtration rate in infants, children and adolescents. Pediatr Clin North Am 34:571–590

    PubMed  CAS  Google Scholar 

  17. National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents (1996) Update on the 1987 Task Force Report on High Blood Pressure in Children and Adolescents: a working group report from the National High Blood Pressure Education Program. Pediatrics 98:649–658

    Google Scholar 

  18. Brendstrup L, Carlsen N, Nielsen SL, Dyrbye M, Eiken M, Krasilnikoff PA, Gertz TC (1983) Micturition cystourethrography using X-ray or scintigraphy in children with reflux. Acta Paediatr Scand 72:559–562

    Article  PubMed  CAS  Google Scholar 

  19. Dikshit MP, Acharya VN, Shikare S, Merchant S, Pardanani DS (1993) Comparison of direct radionuclide cystography with micturating cystourethrography for the diagnosis of vesicoureteric reflux and its correlation with cystoscopic appearances of the ureteric orifices. Nephrol Dial Transplant 8:600–602

    PubMed  CAS  Google Scholar 

  20. Zechmann W, Raushmeier H, Dumfahrt H, Fill H, Joost J, Riccabona G (1983) Value and indication for isotope reflux cystography in children. Acta Medica Austriaca 10:57–60

    PubMed  CAS  Google Scholar 

  21. Zhang G, Day DL, Loken M, Gonzalez R (1987) Grading of reflux by radionuclide cystography. Clin Nucl Med 12:106–109

    Article  PubMed  CAS  Google Scholar 

  22. Tamminen-Mobius T, Brunier E, Ebel KD, Lebowitz R, Olbing H, Seppanen U, Sixt R (1992) Cessation of vesicoureteral reflux for 5 years in infants and children allocated to medical treatment. The International Reflux Study in Children. J Urol 148:1662–1666

    PubMed  CAS  Google Scholar 

  23. Anderson NG, Abbott GD, Mogridge N, Allen RB, Maling TM, Wells JE (1997) Vesicoureteric reflux in the newborn: relationship to fetal pelvic diameter. Pediatr Nephrol 11:610–616

    Article  PubMed  CAS  Google Scholar 

  24. Phan V, Traubici J, Hershenfield B, Stephens D, Rosenblum ND, Geary DF (2004) Vesicoureteral reflux in infants with isolated antenatal hydronephrosis. Pediatr Nephrol 19:819–820

    Article  PubMed  Google Scholar 

  25. Hoberman A, Charron M, Hickey RW, Baskin M, Kearney DH, Wald ER (2003) Imaging studies after a first febrile urinary tract infection in young children. N Engl J Med 348:195–202

    Article  PubMed  Google Scholar 

  26. Goldman M, Bistritzer T, Horne T, Zoareft I, Aladjem M (2000) The etiology of renal scars in infants with pyelonephritis and vesicoureteral reflux. Pediatr Nephrol 14:385–388

    Article  PubMed  CAS  Google Scholar 

  27. Olbing H, Smellie JM, Jodal U, Lax H (2003) New renal scars in children with severe VUR: a 10-year study of randomised treatment. Pediatr Nephrol 18:1128–1131

    Article  PubMed  Google Scholar 

  28. Wennerstrom M, Hansson S, Jodal U, Stokland E (2000) Primary and acquired renal scarring in boys and girls with urinary tract infection. J Pediatr 136:30–34

    Article  PubMed  CAS  Google Scholar 

  29. Ardissino G, Dacco V, Testa S, Bonaudo R, Claris-Appiani A, Taioli E, Marra G, Edefonti A, Sereni F, ItalKid Project (2003) Epidemiology of chronic renal failure in children: data from the ItalKid project. Pediatrics 111:e382–e387

    Article  PubMed  Google Scholar 

  30. Smellie JM, Barratt TM, Chantler C, Gordon I, Prescod NP, Ransley PG, Woolf AS (2001) Medical versus surgical treatment in children with severe bilateral vesicoureteric reflux and bilateral nephropathy: a randomized trial. Lancet 357:1329–1333

    Article  PubMed  CAS  Google Scholar 

  31. Mingin GC, Nguien HT, Baskin LS (2004) Abnormal dimercapto-succinic acid scans predict an increased risk of breakthrough infection in children with vesicoureteral reflux. J Urol 172:1075–1077

    Article  PubMed  Google Scholar 

  32. Rubenstein JN, Maizels M, Kim S, Houston JTB (2003) The PIC cystogram: a novel approach to identify “occult” vesicoureteric reflux in children with febrile urinary tract infections. J Urol 169:2339–2343

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatrics, Second University of Naples, Naples, Italy

    Cesare Polito & Angela La Manna

  2. Department of Radiological Sciences, Nuclear Medicine, Second University of Naples, Naples, Italy

    Pier Francesco Rambaldi & Luigi Mansi

  3. Department of Public Health, Second University of Naples, Naples, Italy

    Giuseppe Signoriello

  4. Clinica Pediatrica, Via L. De Crecchio 2, 80138, Naples, Italy

    Cesare Polito

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  1. Cesare Polito
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  2. Pier Francesco Rambaldi
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  3. Giuseppe Signoriello
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  4. Luigi Mansi
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  5. Angela La Manna
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Correspondence to Cesare Polito.

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Polito, C., Rambaldi, P.F., Signoriello, G. et al. Permanent renal parenchymal defects after febrile UTI are closely associated with vesicoureteric reflux. Pediatr Nephrol 21, 521–526 (2006). https://doi.org/10.1007/s00467-006-0036-3

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  • DOI: https://doi.org/10.1007/s00467-006-0036-3

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