Background: Childhood urinary tract infection (UTI) with or without vesicoureteric reflux (VUR) may predispose to renal scarring. There is no clear consensus in the literature regarding imaging following UTI in infanc...Background: Childhood urinary tract infection (UTI) with or without vesicoureteric reflux (VUR) may predispose to renal scarring. There is no clear consensus in the literature regarding imaging following UTI in infancy. Aims: To define the role of cystography following a first UTI in children aged under 1 year, when urinary tract ultrasonography (US) is normal. Methods: Retrospective data collection of 108 children (216 renal units)-aged under 1 year at the time of a bacteriologically proven UTI. All had a normal US and underwent both catheter cystogram and DMSA test. Sensitivity, specificity, likelihood ratios positive and negative, and diagnostic odds ratio were calculated for VUR on cystography versus scarring on DMSA. Results: VUR was shown in 25 (11.6%) renal units. Scarring on DMSA was seen in 8 (3.7%) kidneys. Only 16%of kidneys with VUR had associated scarring; 50%of scarred kidneys were not associated with VUR. The likelihood ratio positive was 4.95 (95%CI 2.22 to 11.05) and the likelihood ratio negative was 0.56 (95%CI 0.28 to 1.11). The diagnostic odds ratio was 8.9, suggesting that cystography provided little additional information. Conclusion: Since only 16%of children with VUR had an abnormal kidney, the presence of VUR does not identify a susceptible population with an abnormal kidney on DMSA. In the context of a normal ultrasound examination, cystography contributes little to the management of children under the age of 1 year with a UTI. In this context, a normal DMSA study reinforces the redundancy of cystography.展开更多
Purpose The authors investigated whether serum basic fibroblast growth factor (b-FGF) can be used as a noninvasive marker of renal parenchymal damage (scarri ng) in cases of vesicoureteric reflux (VUR). Methods Serum ...Purpose The authors investigated whether serum basic fibroblast growth factor (b-FGF) can be used as a noninvasive marker of renal parenchymal damage (scarri ng) in cases of vesicoureteric reflux (VUR). Methods Serum levels of b-FGF were measured in 120 children with known grade III to gradeV VUR and 21 controlsusin g a standardenzyme-linked immunosorbent assay technique. Results Sixty-five ch ildren had grade IIIVUR, 39 had grade IV, and 16 had grade V. Renal scarring was seen in 43 children on radionuclide scanning. There were no significant differe nces between serum b-FGF levels for different grades of VUR without scarring an d controls. However, serum b-FGF levels were significantly higher in VUR patien ts with renal scarring than in patients with VUR without renal scarring (P < .0 01). Conclusions This report is the first to document serum b-FGF profiles in c hildren with VUR and renal scarring. The authors recommend measuring it as a sim ple, noninvasive marker of renal scarring in cases of VUR.展开更多
文摘Background: Childhood urinary tract infection (UTI) with or without vesicoureteric reflux (VUR) may predispose to renal scarring. There is no clear consensus in the literature regarding imaging following UTI in infancy. Aims: To define the role of cystography following a first UTI in children aged under 1 year, when urinary tract ultrasonography (US) is normal. Methods: Retrospective data collection of 108 children (216 renal units)-aged under 1 year at the time of a bacteriologically proven UTI. All had a normal US and underwent both catheter cystogram and DMSA test. Sensitivity, specificity, likelihood ratios positive and negative, and diagnostic odds ratio were calculated for VUR on cystography versus scarring on DMSA. Results: VUR was shown in 25 (11.6%) renal units. Scarring on DMSA was seen in 8 (3.7%) kidneys. Only 16%of kidneys with VUR had associated scarring; 50%of scarred kidneys were not associated with VUR. The likelihood ratio positive was 4.95 (95%CI 2.22 to 11.05) and the likelihood ratio negative was 0.56 (95%CI 0.28 to 1.11). The diagnostic odds ratio was 8.9, suggesting that cystography provided little additional information. Conclusion: Since only 16%of children with VUR had an abnormal kidney, the presence of VUR does not identify a susceptible population with an abnormal kidney on DMSA. In the context of a normal ultrasound examination, cystography contributes little to the management of children under the age of 1 year with a UTI. In this context, a normal DMSA study reinforces the redundancy of cystography.
文摘Purpose The authors investigated whether serum basic fibroblast growth factor (b-FGF) can be used as a noninvasive marker of renal parenchymal damage (scarri ng) in cases of vesicoureteric reflux (VUR). Methods Serum levels of b-FGF were measured in 120 children with known grade III to gradeV VUR and 21 controlsusin g a standardenzyme-linked immunosorbent assay technique. Results Sixty-five ch ildren had grade IIIVUR, 39 had grade IV, and 16 had grade V. Renal scarring was seen in 43 children on radionuclide scanning. There were no significant differe nces between serum b-FGF levels for different grades of VUR without scarring an d controls. However, serum b-FGF levels were significantly higher in VUR patien ts with renal scarring than in patients with VUR without renal scarring (P < .0 01). Conclusions This report is the first to document serum b-FGF profiles in c hildren with VUR and renal scarring. The authors recommend measuring it as a sim ple, noninvasive marker of renal scarring in cases of VUR.
