Article
Risk assessment of renal cortical scarring with urinary tract
infection by clinical features and ultrasonography
M T Christiana, J H McCollc, J R MacKenzieb, T J Beattiea
a Renal Unit, Royal
Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ, Scotland, UK, b Radiology Department, Royal Hospital for Sick
Children, c Department of
Statistics, University of Glasgow, Scotland, UK
Correspondence to: Dr Beattie email: Jim.Beattie{at}clinmed.gla.ac.uk
Accepted 4 January 2000
AIMS
To address some of the issues
in the ongoing debate over the optimal diagnostic imaging following
childhood urinary tract infection (UTI), by determining the risk of
missing renal cortical scarring which would be detected on a
technetium-99m dimercaptosuccinic acid (DMSA) gold standard if
ultrasound alone were used, factoring for clinical features (upper or
lower tract), UTI recurrence, and age group (infants, preschool, or
school age).
METHODSDetails of UTI clinical
features and recurrence were recorded for 990 children with a proven
UTI, and their DMSA and ultrasound results were compared for each kidney.
RESULTSThe risks of missing DMSA
scarring varied between 0.4% (school age children with solitary lower
tract UTI) and 11.1% (infants with recurrent upper tract UTI).
CONCLUSIONSUTI clinical features
are important in assessing the need for DMSA imaging. Current UK
imaging guidelines are endorsed, although preschool children with
solitary lower tract UTI remain a controversial group and more
attention needs to focused on children with recurrent UTI.
Keywords: urinary tract infection; DMSA; ultrasonography; renal cortical scarring
© 2000 by Archives of Disease in Childhood
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