నైరూప్య

Comparison of VCUG and DMSA scan in the detection of vesicoureteral reflux in children during first febrile urinary tract infection.

Farzaneh Sharifiaghdas, Mehdi Dadpour*, Maziar Salimi, Behzad Narouie, Nasrin Borumandnia, Mohadese Ahmadzade, Hamidreza Rouientan

Objective: High-grade Vesicoureteral Reflux (VUR) is associated with the development of renal scar during febrile Urinary Tract Infection (UTI), subsequently leading to hypertension and chronic kidney disease in adulthood. This study was conducted to evaluate the diagnostic accuracy of Dimercaptosuccinic Acid (DMSA) scan during first febrile UTI in identifying VUR and predicting its severity.

Materials and methods: In this retrospective study, we enrolled children <12 years old with a diagnosis of first febrile UTI who had undergone both VCUG and DMSA scan in our hospital between 2005 and 2020. The sensitivity, specificity, positive and negative predictive values (PPV and NPV) of DMSA scan for detecting VUR was analyzed in all patients and across two age subgroups: ≤ 4 years old and >4 years old.

Results: A total of 208 patients (mean age: 3.34 ± 2.54 years old; male/female (M/F): 59/149) were enrolled. VUR was diagnosed in 261/416 rental units (62.7%) on VCUG. The sensitivity, specificity, PPV and NPV of DMSA scan in detecting VUR was as follows: 52%, 75%, 78% and 48%. After agesubgroup analysis, 158 patients were ≤ 4 years old (M/F: 51/107) and 50 patients were >4 years old (M/F: 8/42). The PPV and NPV for predicting VUR by DMSA scan was 85.6% and 46.3% in ≤ 4 years old and 55.5% and 56.2% in patients more than 4 years old.

Conclusion: The results of this study showed that using DMSA scan for the initial assessment of children with first febrile UTI alone, leads to missing many patients with high-grade VUR; thus, DMSA scan does not have enough accuracy for predicting VUR in comparison with VCUG.