Ultrasound Fails to Delineate Significant Renal Pathology in Children With Urinary Tract Infections

A Case for Dimercapto-Succinic Acid Scintigraphy

Nabeel Hamoui*, Jennifer A. Hagerty, Max Maizels, Elizabeth B Yerkes, Antonio Chaviano, Richard Shore, William E Kaplan, Earl Y Cheng

*Corresponding author for this work

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Purpose: Routine radiological evaluation in children with urinary tract infections includes ultrasound. Additional dimercapto-succinic acid scintigraphy in this setting is a common but not routine practice to determine whether there is parenchymal injury. Because dimercapto-succinic acid scintigraphy involves further time, expense and radiation, we determined whether ultrasound findings could substitute for dimercapto-succinic acid scintigraphy. Therefore, in children with urinary tract infections we researched the incidence of discordant findings between dimercapto-succinic acid scintigraphy and normal ultrasound. Materials and Methods: A retrospective review of children with a history of urinary tract infections who had normal ultrasound and dimercapto-succinic acid scintigraphy within 6 weeks of each other was performed through a chart review. Children with pyelonephritis within 4 months of the radiological tests were excluded. Dimercapto-succinic acid scintigraphy was considered abnormal if there was less than 40% differential function, global atrophy or focal defects. Results: From January 2005 to December 2006, 100 children met inclusion criteria. Median patient age was 4.5 years (range 4 months to 19 years) and 84% were female. Of the 100 children 74 (74%) demonstrated vesicoureteral reflux and 18 (18%) showed abnormal dimercapto-succinic acid scintigraphy despite normal ultrasound. Children with vesicoureteral reflux showed an increased incidence of abnormal dimercapto-succinic acid scintigraphy compared to those without vesicoureteral reflux (20.3% vs 11.5%), although this did not attain statistical significance (p = 0.04). Conclusions: Although dimercapto-succinic acid scintigraphy is not part of routine practice in all children with urinary tract infections and/or vesicoureteral reflux, it is frequently abnormal despite normal ultrasound. Therefore, dimercapto-succinic acid scintigraphy should be considered in these patients to evaluate cortical defects and possibly guide further management.

Original languageEnglish (US)
Pages (from-to)1639-1642
Number of pages4
JournalJournal of Urology
Volume180
Issue number4 SUPPL.
DOIs
StatePublished - Oct 1 2008

Fingerprint

Succinic Acid
Urinary Tract Infections
Radionuclide Imaging
Pathology
Kidney
Vesico-Ureteral Reflux
Pyelonephritis
Incidence
Atrophy
Radiation
Wounds and Injuries

Keywords

  • kidney
  • radionuclide imaging
  • ultrasonography
  • ureter
  • vesico-ureteral reflux

ASJC Scopus subject areas

  • Urology

Cite this

@article{bca808fcc1b745e59a2e81ad8fa6613e,
title = "Ultrasound Fails to Delineate Significant Renal Pathology in Children With Urinary Tract Infections: A Case for Dimercapto-Succinic Acid Scintigraphy",
abstract = "Purpose: Routine radiological evaluation in children with urinary tract infections includes ultrasound. Additional dimercapto-succinic acid scintigraphy in this setting is a common but not routine practice to determine whether there is parenchymal injury. Because dimercapto-succinic acid scintigraphy involves further time, expense and radiation, we determined whether ultrasound findings could substitute for dimercapto-succinic acid scintigraphy. Therefore, in children with urinary tract infections we researched the incidence of discordant findings between dimercapto-succinic acid scintigraphy and normal ultrasound. Materials and Methods: A retrospective review of children with a history of urinary tract infections who had normal ultrasound and dimercapto-succinic acid scintigraphy within 6 weeks of each other was performed through a chart review. Children with pyelonephritis within 4 months of the radiological tests were excluded. Dimercapto-succinic acid scintigraphy was considered abnormal if there was less than 40{\%} differential function, global atrophy or focal defects. Results: From January 2005 to December 2006, 100 children met inclusion criteria. Median patient age was 4.5 years (range 4 months to 19 years) and 84{\%} were female. Of the 100 children 74 (74{\%}) demonstrated vesicoureteral reflux and 18 (18{\%}) showed abnormal dimercapto-succinic acid scintigraphy despite normal ultrasound. Children with vesicoureteral reflux showed an increased incidence of abnormal dimercapto-succinic acid scintigraphy compared to those without vesicoureteral reflux (20.3{\%} vs 11.5{\%}), although this did not attain statistical significance (p = 0.04). Conclusions: Although dimercapto-succinic acid scintigraphy is not part of routine practice in all children with urinary tract infections and/or vesicoureteral reflux, it is frequently abnormal despite normal ultrasound. Therefore, dimercapto-succinic acid scintigraphy should be considered in these patients to evaluate cortical defects and possibly guide further management.",
keywords = "kidney, radionuclide imaging, ultrasonography, ureter, vesico-ureteral reflux",
author = "Nabeel Hamoui and Hagerty, {Jennifer A.} and Max Maizels and Yerkes, {Elizabeth B} and Antonio Chaviano and Richard Shore and Kaplan, {William E} and Cheng, {Earl Y}",
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Ultrasound Fails to Delineate Significant Renal Pathology in Children With Urinary Tract Infections : A Case for Dimercapto-Succinic Acid Scintigraphy. / Hamoui, Nabeel; Hagerty, Jennifer A.; Maizels, Max; Yerkes, Elizabeth B; Chaviano, Antonio; Shore, Richard; Kaplan, William E; Cheng, Earl Y.

In: Journal of Urology, Vol. 180, No. 4 SUPPL., 01.10.2008, p. 1639-1642.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Ultrasound Fails to Delineate Significant Renal Pathology in Children With Urinary Tract Infections

T2 - A Case for Dimercapto-Succinic Acid Scintigraphy

AU - Hamoui, Nabeel

AU - Hagerty, Jennifer A.

AU - Maizels, Max

AU - Yerkes, Elizabeth B

AU - Chaviano, Antonio

AU - Shore, Richard

AU - Kaplan, William E

AU - Cheng, Earl Y

PY - 2008/10/1

Y1 - 2008/10/1

N2 - Purpose: Routine radiological evaluation in children with urinary tract infections includes ultrasound. Additional dimercapto-succinic acid scintigraphy in this setting is a common but not routine practice to determine whether there is parenchymal injury. Because dimercapto-succinic acid scintigraphy involves further time, expense and radiation, we determined whether ultrasound findings could substitute for dimercapto-succinic acid scintigraphy. Therefore, in children with urinary tract infections we researched the incidence of discordant findings between dimercapto-succinic acid scintigraphy and normal ultrasound. Materials and Methods: A retrospective review of children with a history of urinary tract infections who had normal ultrasound and dimercapto-succinic acid scintigraphy within 6 weeks of each other was performed through a chart review. Children with pyelonephritis within 4 months of the radiological tests were excluded. Dimercapto-succinic acid scintigraphy was considered abnormal if there was less than 40% differential function, global atrophy or focal defects. Results: From January 2005 to December 2006, 100 children met inclusion criteria. Median patient age was 4.5 years (range 4 months to 19 years) and 84% were female. Of the 100 children 74 (74%) demonstrated vesicoureteral reflux and 18 (18%) showed abnormal dimercapto-succinic acid scintigraphy despite normal ultrasound. Children with vesicoureteral reflux showed an increased incidence of abnormal dimercapto-succinic acid scintigraphy compared to those without vesicoureteral reflux (20.3% vs 11.5%), although this did not attain statistical significance (p = 0.04). Conclusions: Although dimercapto-succinic acid scintigraphy is not part of routine practice in all children with urinary tract infections and/or vesicoureteral reflux, it is frequently abnormal despite normal ultrasound. Therefore, dimercapto-succinic acid scintigraphy should be considered in these patients to evaluate cortical defects and possibly guide further management.

AB - Purpose: Routine radiological evaluation in children with urinary tract infections includes ultrasound. Additional dimercapto-succinic acid scintigraphy in this setting is a common but not routine practice to determine whether there is parenchymal injury. Because dimercapto-succinic acid scintigraphy involves further time, expense and radiation, we determined whether ultrasound findings could substitute for dimercapto-succinic acid scintigraphy. Therefore, in children with urinary tract infections we researched the incidence of discordant findings between dimercapto-succinic acid scintigraphy and normal ultrasound. Materials and Methods: A retrospective review of children with a history of urinary tract infections who had normal ultrasound and dimercapto-succinic acid scintigraphy within 6 weeks of each other was performed through a chart review. Children with pyelonephritis within 4 months of the radiological tests were excluded. Dimercapto-succinic acid scintigraphy was considered abnormal if there was less than 40% differential function, global atrophy or focal defects. Results: From January 2005 to December 2006, 100 children met inclusion criteria. Median patient age was 4.5 years (range 4 months to 19 years) and 84% were female. Of the 100 children 74 (74%) demonstrated vesicoureteral reflux and 18 (18%) showed abnormal dimercapto-succinic acid scintigraphy despite normal ultrasound. Children with vesicoureteral reflux showed an increased incidence of abnormal dimercapto-succinic acid scintigraphy compared to those without vesicoureteral reflux (20.3% vs 11.5%), although this did not attain statistical significance (p = 0.04). Conclusions: Although dimercapto-succinic acid scintigraphy is not part of routine practice in all children with urinary tract infections and/or vesicoureteral reflux, it is frequently abnormal despite normal ultrasound. Therefore, dimercapto-succinic acid scintigraphy should be considered in these patients to evaluate cortical defects and possibly guide further management.

KW - kidney

KW - radionuclide imaging

KW - ultrasonography

KW - ureter

KW - vesico-ureteral reflux

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