Children's Hospital at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA.
J Urol. 2010 Oct;184(4 Suppl):1703-9. doi: 10.1016/j.juro.2010.04.050. Epub 2010 Aug 21.
Evaluation in children after febrile urinary tract infection involves voiding cystourethrogram, which emphasizes urinary reflux rather than renal risk. We believe that early dimercapto-succinic acid renal scan after febrile urinary tract infection predicts clinically significant reflux and which children should undergo voiding cystourethrogram. The criticism of this approach is that some reflux and preventable renal damage would be missed. This study validates the use of initial dimercapto-succinic scan and presents 5-year renal outcomes.
We prospectively studied children with febrile urinary tract infection using initial dimercapto-succinic acid renal scan, voiding cystourethrogram and renal/bladder ultrasound. Children with anatomical or neurological genitourinary abnormality and protocol failures were excluded from analysis. Dimercapto-succinic acid scan was repeated at 6 months if initially abnormal. Followup was done every 6 months in all children for at least 5 years.
A total of 121 children fit study inclusion criteria and completed the 5-year study. Overall 88 initial dimercapto-succinic acid scans (73%) were abnormal and 78 children (64%) had urinary reflux. The OR of having clinically significant reflux predicted by abnormal initial scan was 35.4. Abnormal followup scan did not predict clinically significant reflux. Overall subsequent urinary tract infection developed in 32 patients (26.5%) and 27 (85%) had an abnormal initial scan. No child with a normal initial scan had clinically significant reflux.
Dimercapto-succinic acid scan can predict clinically significant reflux and children at greatest renal risk. Initial dimercapto-succinic acid scan should be done in all children after febrile urinary tract infection while voiding cystourethrogram should be reserved for those with an abnormal initial dimercapto-succinic acid scan.
儿童发热性尿路感染后的评估包括排尿性膀胱尿道造影，该检查强调尿反流而不是肾脏风险。我们认为，发热性尿路感染后早期二巯丁二酸肾扫描可预测有临床意义的反流，哪些儿童应进行排尿性膀胱尿道造影。这种方法的批评是，一些反流和可预防的肾损伤可能会被遗漏。本研究验证了初始二巯丁二酸扫描的使用，并提出了 5 年的肾脏预后。
我们前瞻性地研究了发热性尿路感染患儿，使用初始二巯丁二酸酸肾扫描、排尿性膀胱尿道造影和肾脏/膀胱超声。排除有解剖或神经源性泌尿生殖系统异常和方案失败的儿童进行分析。如果初始异常，二巯丁二酸扫描在 6 个月时重复。所有儿童均进行至少 5 年的每 6 个月一次的随访。
共有 121 名儿童符合研究纳入标准，并完成了 5 年的研究。总的来说，88 次初始二巯丁二酸扫描（73%）异常，78 名儿童（64%）有尿反流。异常初始扫描预测有临床意义反流的比值比为 35.4。异常随访扫描不能预测有临床意义的反流。总的来说，32 名患儿（26.5%）随后发生尿路感染，其中 27 名患儿（85%）有异常初始扫描。无初始扫描正常的患儿出现有临床意义的反流。
二巯丁二酸扫描可预测有临床意义的反流和肾脏风险最大的儿童。发热性尿路感染后所有儿童均应行二巯丁二酸扫描，而仅对初始二巯丁二酸扫描异常的儿童行排尿性膀胱尿道造影。
