University of Helsinki, Helsinki, Finland.
Department of Pediatric Surgery, Uppsala University Children's Hospital, Uppsala, Sweden.
Acta Paediatr. 2019 Apr;108(4):751-756. doi: 10.1111/apa.14536. Epub 2018 Sep 14.
A top-down approach is widely used for detecting vesicoureteral reflux (VUR) in children with febrile urinary tract infections. We evaluated the diagnostic value of renal scintigraphy in predicting VUR in children with antenatal hydronephrosis (AHN).
The voiding cystourethrogram (VCUG) and renal scintigraphy results of 125 AHN patients (76% male) admitted to the Children's Hospital of Helsinki University, Finland, from 2003 to 2013 were analysed. Of those, 94 had nonrefluxing hydronephrosis, nine had low-grade VUR and 22 had high-grade VUR.
Scintigraphy was performed at a median age of 1.4 (0.8-15.6) months. In patients with high-grade VUR, the differential renal function (DRF) of the worse kidney was significantly lower than in patients without VUR, with a median of 35% and interquartile range (IQR) of 20-45 versus 47% (IQR: 44-49), (p < 0.001). There was no difference between patients with low-grade VUR and patients without VUR (p = 0.181). DRFs below 44% showed a sensitivity of 73% and specificity of 79% and predicted significantly high-grade VUR (odds ratio 9.82, 95% confidence interval 3.44-28.05, p < 0.001) in the univariate analysis.
A DRF below 44% predicted high-grade VUR in patients with AHN and supported the decision to perform VCUG.
在患有发热性尿路感染的儿童中，广泛采用自上而下的方法来检测膀胱输尿管反流（VUR）。我们评估了肾闪烁显像术在预测伴有产前肾积水（AHN）的儿童中 VUR 的诊断价值。
分析了 2003 年至 2013 年期间芬兰赫尔辛基大学儿童医院收治的 125 例 AHN 患者（76%为男性）的排尿性膀胱尿道造影（VCUG）和肾闪烁显像结果。其中 94 例为无反流性肾积水，9 例为低级别 VUR，22 例为高级别 VUR。
闪烁显像术在中位年龄 1.4 岁（0.8-15.6 个月）时进行。在高级别 VUR 患者中，较差肾脏的分肾功能（DRF）明显低于无 VUR 患者，中位数为 35%，四分位距（IQR）为 20-45 与 47%（IQR：44-49）（p<0.001）。低级别 VUR 患者与无 VUR 患者之间无差异（p=0.181）。DRF 低于 44%时，其敏感性为 73%，特异性为 79%，并在单变量分析中显著预测高级别 VUR（优势比 9.82，95%置信区间 3.44-28.05，p<0.001）。
在伴有 AHN 的患者中，DRF 低于 44%预测高级别 VUR，并支持进行 VCUG 的决策。
