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      Semiquantitative analysis of power doppler ultrasonography versus Tc-99m DMSA scintigraphy in diagnostic and severity assessment of acute childhood pyelonephritis

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          Abstract

          Background

          This study aimed to compare the diagnostic and predictive value of power Doppler ultrasonography (PDU) with Tc-99m dimercaptosuccinic acid (DMSA) renal scintigraphy in pediatric acute pyelonephritis (APN) using a semiquantitative analysis system.

          Methods

          A total of 92 children and infants (184 kidneys) were hospitalized with possible APN. All children were examined by PDU and DMSA scintigraphy within 72 hours of admission. An empiric 9-point semiquantitative analysis system was used to sort kidneys into four grades (grade 0–III). Patients with several episodes of APN and congenital structural anomalies were excluded.

          Results

          Of 184 kidneys, we found 68 abnormal (grade I–III) and 116 normal (Grade 0) with DMSA scintigraphy, and 84 abnormal and 100 normal with PDU. In all, 23 kidneys were shown to be diseased by PDU but normal on DMSA scintigraphy while 7 kidneys showed the opposite trend. The sensitivity and specificity of PDU for diagnosing APN was 89.7% and 80.2%, respectively (P<0.05). In children older than 6 months, the sensitivity was higher (92%, P<0.05) than that in children younger than 6 months (87%, P<0.05). A moderate agreement (41%, P<0.05) on grade was found between the two methods.

          Conclusions

          With the help of a semiquantitative analysis system, PDU can obviate the use of DMSA scintigraphy in children older than 6 months for APN diagnosis.

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          Most cited references25

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          EAU guidelines on vesicoureteral reflux in children.

          Serdar Tekgul, Hubertus Riedmiller, Piet Hoebeke … (2012)
          Primary vesicoureteral reflux (VUR) is a common congenital urinary tract abnormality in children. There is considerable controversy regarding its management. Preservation of kidney function is the main goal of treatment, which necessitates identification of patients requiring early intervention. To present a management approach for VUR based on early risk assessment. A literature search was performed and the data reviewed. From selected papers, data were extracted and analyzed with a focus on risk stratification. The authors recognize that there are limited high-level data on which to base unequivocal recommendations, necessitating a revisiting of this topic in the years to come. There is no consensus on the optimal management of VUR or on its diagnostic procedures, treatment options, or most effective timing of treatment. By defining risk factors (family history, gender, laterality, age at presentation, presenting symptoms, VUR grade, duplication, and other voiding dysfunctions), early stratification should allow identification of patients at high potential risk of renal scarring and urinary tract infections (UTIs). Imaging is the basis for diagnosis and further management. Standard imaging tests comprise renal and bladder ultrasonography, voiding cystourethrography, and nuclear renal scanning. There is a well-documented link with lower urinary tract dysfunction (LUTD); patients with LUTD and febrile UTI are likely to present with VUR. Diagnosis can be confirmed through a video urodynamic study combined with a urodynamic investigation. Early screening of the siblings and offspring of reflux patients seems indicated. Conservative therapy includes watchful waiting, intermittent or continuous antibiotic prophylaxis, and bladder rehabilitation in patients with LUTD. The goal of the conservative approach is prevention of febrile UTI, since VUR will not damage the kidney when it is free of infection. Interventional therapies include injection of bulking agents and ureteral reimplantation. Reimplantation can be performed using a number of different surgical approaches, with a recent focus on minimally invasive techniques. While it is important to avoid overtreatment, finding a balance between cases with clinically insignificant VUR and cases that require immediate intervention should be the guiding principle in the management of children presenting with VUR. Copyright © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.
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            Absolute and relative accuracy of rapid urine tests for urinary tract infection in children: a meta-analysis.

            J. Williams, Petra Macaskill, Jonathan Craig … (2010)
            Rapid urine tests, such as microscopy, for bacteria and white cells, and dipsticks, for leucocyte esterase and nitrites, are often used in children that are unwell to guide early diagnosis and treatment of urinary tract infection. We aimed to establish whether these tests were sufficiently sensitive to avoid urine culture in children with negative results and to compare the accuracy of dipsticks with microscopy. Medline, Embase, and reference lists were searched. Studies were included if urine culture results were compared with rapid tests in children. Data were analysed to obtain absolute and relative accuracy estimates. Data from 95 studies in 95 703 children were analysed. Summary estimates for sensitivity and specificity for microscopy for Gram-stained bacteria were 91% (95% CI 80-96) and 96% (92-98), for unstained bacteria were 88% (75-94) and 92% (84-96), for urine white cells were 74% (67-80) and 86% (82-90), for leucocyte esterase or nitrite positive dipstick were 88% (82-91) and 79% (69-87), and for nitrite-only positive dipstick were 49% (41-57) and 98% (96-99). Microscopy for bacteria with Gram stain had higher accuracy than other laboratory tests with relative diagnostic odds ratio compared with bacteria without Gram stain of 8.7 (95% CI 1.8-41.1), white cells of 14.5 (4.7-44.4), and nitrite of 22.0 (0.7-746.3). Microscopy for white cells should not be used for the diagnosis of urinary tract infection because its accuracy is no better than that of dipstick, laboratory facilities are needed, and results are delayed. Rapid tests are negative in around 10% of children with a urinary tract infection and cannot replace urine culture. If resources allow, microscopy with Gram stain should be the single rapid test used. 2010 Elsevier Ltd. All rights reserved.
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              Febrile urinary tract infections in young children: recommendations for the diagnosis, treatment and follow-up.

              R Chimenz, Marco Materassi, Anita Ammenti … (2012)
              We report the recommendations for the diagnosis, treatment, imaging evaluation and use of antibiotic prophylaxis in children with the first febrile urinary tract infection, aged 2 months to 3 years. They were prepared by a working group of the Italian Society of Pediatric Nephrology after careful review of the available literature and a consensus decision, when clear evidence was not available. These recommendations are endorsed by the Italian Society of Pediatric Nephrology. They can also be a tool of comparison with other existing guidelines in issues in which much controversy still exists. © 2011 The Author(s)/Acta Paediatrica © 2011 Foundation Acta Paediatrica.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Transl Pediatr
                Journal ID (iso-abbrev): Transl Pediatr
                Journal ID (publisher-id): TP
                Title: Translational Pediatrics
                Publisher: AME Publishing Company
                ISSN (Print): 2224-4336
                ISSN (Electronic): 2224-4344
                Publication date (Print and electronic): August 2020
                Publication date (Print): August 2020
                Volume: 9
                Issue: 4
                Pages: 487-495
                Affiliations
                [1 ]Department of Ultrasound, the Second Affiliated Hospital of Wenzhou Medical University , Wenzhou, China;
                [2 ]Department of Pediatrics, the Second Affiliated Hospital of Wenzhou Medical University , Wenzhou, China
                Author notes

                Contributions: (I) Conception and design: H Zhu, Y Yang; (II) Administrative support: Y Yang; (III) Provision of study materials or patients: All authors; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

                Correspondence to: Wenjie Zheng. Department of Pediatrics, the Second Affiliated Hospital of Wenzhou Medical University, 109 Xueyuan Western Road, Wenzhou, China. Email: wzwjzheng@ 123456sina.com . Yan Yang, Department of Ultrasound, the Second Affiliated Hospital of Wenzhou Medical University 109 Xueyuan Western Road, Wenzhou, China. Email: 1193928739@ 123456qq.com .
                Article
                Publisher ID: tp-09-04-487
                DOI: 10.21037/tp-20-59
                PMC ID: 7475307
                PubMed ID: 32953546
                SO-VID: 0450d079-80aa-4db3-ac70-58c21b9ad138
                Copyright © 2020 Translational Pediatrics. All rights reserved.
                License:

                Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0.

                History
                Date received : 14 February 2020
                Date accepted : 22 July 2020
                Categories
                Subject: Original Article

                Keywords: power doppler ultrasonography (pdu),tc-99m dimercaptosuccinic acid renal scintigraphy (tc-99m dmsa renal scintigraphy),acute pyelonephritis (apn),semiquantitative analysis system
                Data availability:
                Keywords: power doppler ultrasonography (pdu), tc-99m dimercaptosuccinic acid renal scintigraphy (tc-99m dmsa renal scintigraphy), acute pyelonephritis (apn), semiquantitative analysis system

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