Pediatric Urology, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey.
Department of Urology, Division of Pediatric Urology, School of Medicine, Marmara University, Istanbul, Turkey.
Int Urol Nephrol. 2021 Oct;53(10):1963-1968. doi: 10.1007/s11255-021-02934-3. Epub 2021 Jul 2.
There are scanty data on the rate of abnormal Tc-99 m dimercaptosuccinic acid (DMSA) renal scintigraphy and associated factors in children older than 5 years with diagnosis of VUR. We do not have knowledge about which older children should undergo DMSA after VUR diagnosis. This study aims to assess the rate of abnormal DMSA findings and associated factors in children older than 5 years of age diagnosed with VUR.
We retrospectively reviewed the medical records of 258 children with VUR diagnosed at or older than 5 year age. 179 children [42 (23.5%) males and 137 (76.5%) females] with complete data were included. 268 reflux units were compared according to gender, bilaterality, grade, reflux phase at voiding cystourethrography, febrile urinary tract infection (fUTI), lower urinary tract dysfunction (LUTD), and DMSA findings with uni- and multivariate analysis.
The median age was 110 (60-216) months. VUR grades were I, II, and III in 197 (73.6%) units and IV-V in 71 (26.4%). 138 (51.5%) renal units had abnormal DMSA. VUR grade (p < 0.01), unilaterality (p = 0.048), and fUTI (p = 0.031) in univariate but only grade and unilaterality in multivariate analysis are significantly associated with abnormal DMSA. Although reflux at filling phase was predominant in high-grade VUR group, reflux at voiding phase (p = 0.006) in low-medium-grade (1-3) VUR was associated with abnormal DMSA.
Children older than 5 years of age diagnosed with VUR should be regarded as a high-risk group for abnormal DMSA regardless of gender, unilaterality, grade, reflux phase, fUTI, and LUTD.
对于诊断为 VUR 的 5 岁以上儿童，有关异常 Tc-99m 二巯丁二酸（DMSA）肾闪烁显像及其相关因素的数据甚少。我们不知道哪些年龄较大的儿童在 VUR 诊断后应进行 DMSA 检查。本研究旨在评估诊断为 VUR 的 5 岁以上儿童中异常 DMSA 发现的发生率和相关因素。
我们回顾性地审查了在 5 岁或以上年龄诊断为 VUR 的 258 名儿童的病历。共有 179 名儿童[42 名（23.5%）男性和 137 名（76.5%）女性]资料完整，纳入研究。根据性别、双侧性、等级、排尿性膀胱尿道造影时的反流相、发热性尿路感染（fUTI）、下尿路功能障碍（LUTD）和 DMSA 结果，对 268 个反流单位进行了单因素和多因素分析。
中位年龄为 110（60-216）个月。VUR 分级为 I、II 和 III 级者 197 个单位（73.6%），IV-V 级者 71 个单位（26.4%）。138 个（51.5%）肾单位 DMSA 异常。单因素分析显示，VUR 分级（p<0.01）、单侧性（p=0.048）和 fUTI（p=0.031）与 DMSA 异常有关，但多因素分析仅显示分级和单侧性与 DMSA 异常有关。尽管在高级别 VUR 组中充盈相反流占主导地位，但在低-中级别（1-3）VUR 中，排空相反流（p=0.006）与 DMSA 异常有关。
诊断为 VUR 的 5 岁以上儿童无论性别、单侧性、分级、反流相、fUTI 和 LUTD 如何，均应视为异常 DMSA 的高危人群。
