Abstract
The aim of this study was to define in children younger than 2 years of age the diagnostic significance of clinical and laboratory findings to localize site of febrile urinary tract infection. We reviewed the records of 185 children younger than 2 years of age admitted to hospital with febrile urinary tract infection. Patients were divided into having either acute pyelonephritis or acute cystitis according to the presence or absence of acute lesions on dimercaptosuccinic acid (DMSA) renal scintigraphy. Clinical and laboratory [white blood cell count (WBC), urinalysis, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)] findings were compared between the two groups using Student’s t test, chi-square test, and multivariate analysis. Patients with pyelonephritis had statistically significant higher age, WBC, ESR, and CRP than those with cystitis. Although the sensitivity of the tests was 80–100%, their specificity was <28%. On multivariate analysis, 33% of patients with cystitis were diagnosed as having pyelonephritis, whereas 22% of those with pyelonephritis were considered to have cystitis. Given the low specificity of clinical findings and available laboratory tests to define the site of urine infection in this age group, we recommend DMSA renal scintigram as the test of choice to make the diagnosis of acute pyelonephritis in these patients.
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Hoberman A, Chao HP, Keller DM, Hickey R, Davis HW, Ellis D (1993) Prevalence of urinary tract infection in febrile infants. J Pediatr 123:17–23
Martinelli J, Claesson I, Lidin-Janson G, Jodal U (1995) Urinary infection, reflux and renal scarring in females continuously followed for 13–38 years. Pediatr Nephrol 9:131–136
Smellie J, Edwards D, Hunter N, Normand ICS, Prescod N (1975) Vesicoureteral reflux and renal scarring. Kidney Int 8:565–575
Rushton HG (1997) The evaluation of acute pyelonephritis and renal scarring with technetium 99m-dimercaptosuccinic acid renal scintigraphy: evolving concepts and future directions. Pediatr Nephrol 11:108–120
Hoberman A, Wald ER, Hickey RW, Baskin M, Charron M, Majd M, Kearney DH, Reynolds EA, Ruley J, Janosky JE (1999) Oral versus initial intravenous therapy for urinary tract infections in young febrile children. Pediatrics 104:79–86
Jakobsson B, Soderlundh S, Berg U (1992) Diagnostic significance of 99mTc-dimercaptosuccinic acid (DMSA) scintigraphy in urinary tract infection. Arch Dis Child 67:1338–1342
Benador D, Benador N, Slosman DO, Nussle D, Mermillod B, Girardin E (1994) Cortical scintigraphy in the evaluation of renal parenchyma changes in children with pyelonephritis. J Pediatr 124:17–20
Ataei N, Madani A, Habibi R, Khorasani M (2005) Evaluation of acute pyelonephritis with DMSA scans in children presenting after the age of 5 years. Pediatr Nephrol 20:1439–1444
Jacobson SH, Eklof O, Eriksson CG, Lins LE, Tidgren B, Winberg J (1989) Development of hypertension and uraemia after pyelonephritis in childhood: 27 year follow-up. BMJ 299:703–706
Gleeson FV, Gordon I (1991) Imaging in urinary tract infection. Arch Dis Child 66:1282–1283
Benador D, Benador N, Slosman D, Mermillod B, Girardin E (1997) Are younger children at highest risk of renal sequelae after pyelonephritis? Lancet 349:17–19
Piepsz A, Blaufox MD, Gordon I, Granerus G, Majd M, O’Reilly P, Rosenberg AR, Rossleigh MA, Sixt R (1999) Consensus on renal cortical scintigraphy in children with urinary tract infection. Scientific committee on radionuclides in nephrourology. Semin Nucl Med 29:160–174
Andrich MP, Majd M (1992) Diagnostic imaging in the evaluation of the first urinary tract infection in infants and young children. Pediatrics 90:436–441
De Sadeleer C, Tondeur M, Melis K, Van Espen MB, Verelst J, Ham H, Piepsz A (2000) A multicenter trial on interobserver reproducibility in reporting on 99mTc-DMSA planar scintigraphy: a Belgian survey. J Nucl Med 41:23–26
Basiratnia M, Nochi AH, Lofti M, Alavi MS (2006) Power Doppler sonographic evaluation of acute childhood pyelonephritis. Pediatr Nephrol 21:1854–1857
American Academy of Pediatrics, Committee on Quality Improvement, Subcommittee on Urinary Tract Infection (1999) Practice parameter: the diagnosis, treatment and evaluation of the initial urinary tract infection in febrile infants and young children. Pediatrics 103:843–852
Galen RS (1975) Predictive values of laboratory tests. Am J Cardiol 36:536–538
Arnold AJ, Brownless SM, Carty HM, Rickwood AM (1990) Detection of renal scarring by DMSA scanning-an experimental study. J Pediatr Surg 25:391–393
Rushton HG, Majd M (1992) Dimercaptosuccinic acid renal scintigraphy for the evaluation of pyelonephritis and scarring: a review of experimental and clinical studies. J Urol 148:1726–1732
Majd M, Rushton HG, Chandra R, Andrich MP, Tardiff CP, Rashti F (1997) Technetium-99-m-DMSA renal cortical scintigraphy to detect experimental acute pyelonephritis in piglets: comparison of planar (pinhole) and SPECT imaging. J Nucl Med 38:1731–1734
Risdon RA, Gosley ML, Parkhouse HF, Gordon I, Ransley PG (1994) Renal pathology and the 99mTc-DMSA image during the evolution of the early pyelonephritis scar: an experimental study. J Urol 151:767–773
Giblin JG, O’Connor KP, Fildes RD, Harkness B, Levin K, Newsome JT, Sesternhenn I, Gibbons MD (1993) The diagnosis of acute pyelonephritis in the piglet using single photon emission computerized tomography dimercaptosuccinic acid scintigraphy: a pathological correlation. J Urol 150:759–762
Craig JC, Wheeler DM, Irwig L, Howman-Giles RB (2000) How accurate is dimercaptosuccinic acid scintigraphy for the diagnosis of acute pyelonephritis? A meta-analysis of experimental studies. J Nucl Med 41:986–993
Linshaw MA (1999) Controversies in childhood urinary tract infections. World J Urol 17:383–395
Biggi A, Dardanell L, Pomero G, Cussino P, Noello C, Sernia O, Spada A, Camuzzini G (2001) Acute renal cortical scintigraphy in children with a first urinary tract infection. Pediatr Nephrol 16:733–738
Stokland E, Hellstrom M, Jacobsson B, Jodal U, Lungren P, Sixt R (1996) Early 99mTC dimercaptosuccinic acid (DMSA) scintigraphy in symptomatic first-time urinary tract infection. Acta Paediatr 85:430–436
Tappin DM, Murphy AM, Mocan H, Shaw R, Beattie TJ, McAllister TA, MacKenzie JR (1989) A prospective study of children with first acute symptomatic E. coli urinary infection. Early 99mtechnitium dimercaptosuccinic acid scan appearance. Acta Paediatr Scand 78:923–929
Hoberman A, Wald ER, Reynolds EA, Penchansky L, Charron M (1996) Is urine culture necessary to rule out urinary tract infection in young febrile children? Pediatr Infect Dis 15:304–309
Madj M, Rushton HG, Jantausch B, Wiedermann BL (1991) Relationship among vesicoureteral reflux, P-fimbriated Escherichia coli, and acute pyelonephritis in children with febrile urinary tract infection. J Pediatr 119:578–585
Mellis K, Vandeviveri J, Hoskens C, Vervaet A, Sand A, Van Acker KJ (1992) Involvement of the renal parenchyma in acute urinary tract infection: the contribution of 99mTc dimercaptosuccinic acid scan. Eur J Pediatr 151:536–539
Donoso G, Lobo G, Arnell F, Arteaga MP, Hevia P, Rosati P, Lagos E, Wolff C, Perez A, Jimenez C (2004) Tc 99M DMSA scintigraphy in children with a first episode of acute pyelonephritis: correlation with laboratory tests, echography and the presence of vesico-ureteral reflux. Rev Med Chil 132:58–64
Fairley KF, Carson NE, Gutch RC, Leighton P, Grounds AD, Laird EC, McCallum PH, Sleeman RL, O’Keefe CM (1971) Site of urinary tract-infection in general practice. Lancet 2:615–618
Fisher MC (1999) Pyelonephritis at home-why not? Pediatrics 104:109–111
Lozano JM (2004) Treatment of acute pyelonephritis in children. Conclusions should have been more cautious. BMJ 328:957
Jones B, Jarvis P, Lewis JA, Ebbutt AF (1996) Trials to assess equivalence: the importance of rigorous methods. BMJ 313:36–39
Johnson JR, Stamm WE (1989) Urinary tract infections in women: diagnosis and treatment. Ann Intern Med 111:906–917
Gervaix A, Galetto-Lacour A, Gueron T, Vadas L, Zamora S, Suter S, Girardin E (2001) Uselfulness of procalcitonin and C-reactive protein rapid tests for management of children with urinary tract infection. Pediatr Infect Dis J 20:507–511
Pecile P, Miorin E, Romanello C, Fallet E, Valent F, Giacomuzzi F, Tenore A (2004) Procalcitonin: A marker of severity of acute pyelonephritis in children. Pediatrics 114:e249–e254
Bigot S, Leblond P, Foucher C, Hue V, D’ Herbomez M, Foulard M (2005) Uselfulness of procalcitonin for the diagnosis of acute pyelonephritis in children. Arch Pediatr 12:1075–1080
Guven AG, Kazdal HZ, Koyun M, Aydin F, Gungor F, Akman S, Baysal YE (2006) Accurate diagnosis of acute pyelonephritis: how helpful is procalcitonin. Nucl Med Comm 27:715–721
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Garin, E.H., Olavarria, F., Araya, C. et al. Diagnostic significance of clinical and laboratory findings to localize site of urinary infection. Pediatr Nephrol 22, 1002–1006 (2007). https://doi.org/10.1007/s00467-007-0465-7
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DOI: https://doi.org/10.1007/s00467-007-0465-7