Division of Pediatric Urology, James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD.
Urology. 2013 Oct;82(4):905-9. doi: 10.1016/j.urology.2013.04.026. Epub 2013 Jun 14.
To assess the sensitivity and negative predictive value (NPV) of screening renal and bladder ultrasound (RBUS) after initial febrile urinary tract infection (UTI) among patients with clinically significant vesicoureteral reflux (VUR).
A retrospective review was performed of all children <2 years of age who presented with a febrile UTI between 2004 and 2011. The sensitivity and NPV of initial RBUS was calculated among patients who were found to have high-grade (IV-V) VUR. Additionally, initial RBUS among patients with evidence of photopenia on dimercaptosuccinic acid (DMSA) scan or who underwent surgical intervention were reviewed.
One hundred forty-four patients with febrile UTI were identified; available RBUS, voiding cystourethrogram (VCUG), and DMSA results for each kidney were reviewed. One hundred fifty-eight kidneys had evidence of VUR on VCUG, and initial RBUS demonstrated abnormality in 25 (sensitivity 0.17). Forty-five kidneys had high-grade VUR and RBUS revealed abnormality in 16 (sensitivity 0.36). One hundred seventy-eight kidneys had no evidence of abnormality on initial RBUS, and 136 (76%) were found to have VUR (NPV 0.24), of which 31 had high-grade VUR (NPV 0.83). Seven kidneys had scarring on DMSA and initial RBUS was normal in 4 (57%). Twelve of 19 patients (63%) who eventually underwent surgical intervention had a normal initial RBUS.
RBUS has poor sensitivity and NPV for detecting high-grade VUR in patients <2 years who present with a febrile UTI. A significant number of patients who were diagnosed with high-grade VUR, renal scarring, or underwent surgical correction of VUR had a negative screening RBUS.
评估在有临床意义的膀胱输尿管反流（VUR）的患者中，初始发热性尿路感染（UTI）后筛查肾脏和膀胱超声（RBUS）的敏感性和阴性预测值（NPV）。
对 2004 年至 2011 年间就诊的所有<2 岁的发热性 UTI 患者进行了回顾性分析。计算了在发现存在高级（IV-V）VUR 的患者中初始 RBUS 的敏感性和 NPV。此外，还回顾了初始 RBUS 在存在二巯丁二酸（DMSA）扫描光密度降低证据或接受手术干预的患者中的情况。
确定了 144 例发热性 UTI 患者，对每个肾脏的可用 RBUS、排尿性膀胱尿道造影（VCUG）和 DMSA 结果进行了回顾。158 个肾脏在 VCUG 上有 VUR 的证据，初始 RBUS 显示异常 25 个（敏感性 0.17）。45 个肾脏有高级别 VUR，RBUS 显示异常 16 个（敏感性 0.36）。178 个肾脏初始 RBUS 无异常，其中 136 个（76%）有 VUR（NPV 0.24），其中 31 个有高级别 VUR（NPV 0.83）。7 个肾脏在 DMSA 上有瘢痕，初始 RBUS 正常 4 个（57%）。最终进行手术干预的 19 例患者中的 12 例（63%）初始 RBUS 正常。
对于<2 岁的发热性 UTI 患者，RBUS 对检测高级别 VUR 的敏感性和 NPV 均较差。大量被诊断为高级别 VUR、肾瘢痕形成或接受 VUR 手术矫正的患者，其 RBUS 筛查结果为阴性。
