MP44-06 THE MODIFIED TOP DOWN APPROACH TO IMAGING: ANORMAL DMSA PREDICTS RECURRENT FEBRILE UTI RISK

Abstract

You have accessJournal of UrologyPediatrics: Urinary Tract Infection & Vesicoureteral Relux1 Apr 2014MP44-06 THE MODIFIED TOP DOWN APPROACH TO IMAGING: ANORMAL DMSA PREDICTS RECURRENT FEBRILE UTI RISK Melise Keays, Colby Adams, Kimberly Mizener, Karen Pritzker, William Smith, Janelle Traylor, Carlos Villanueva, Warren Snodgrass, and Nicol C. Bush Melise KeaysMelise Keays More articles by this author , Colby AdamsColby Adams More articles by this author , Kimberly MizenerKimberly Mizener More articles by this author , Karen PritzkerKaren Pritzker More articles by this author , William SmithWilliam Smith More articles by this author , Janelle TraylorJanelle Traylor More articles by this author , Carlos VillanuevaCarlos Villanueva More articles by this author , Warren SnodgrassWarren Snodgrass More articles by this author , and Nicol C. BushNicol C. Bush More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1381AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives The goal of imaging after febrile UTI (FUTI) in children is to identify anatomic anomalies predisposing to recurrent FUTI and/or renal damage. Recommendations have varied from no imaging after 1st FUTI to renal/bladder ultrasound (RBUS) and VCUG in all patients. We used DMSA obtained ≥3 months after FUTI to evaluate baseline renal damage (Snodgrass et al, 2013) and determined rates of VUR and recurrent FUTI longitudinally. We present results of this modified “top-down” approach. Methods Beginning in 2008, consecutive children referred following FUTI underwent standardized evaluation and management. Imaging comprised RBUS, and DMSA ≥ 3 months after the last FUTI. Abnormal DMSA was defined as function <44% and/or cortical renal defect(s). VCUG was only done in those with abnormal DMSA if not obtained before referral. Patients with normal DMSA were observed without antibiotic prophylaxis regardless of VUR status, whereas those with abnormal DMSA had injection or reimplantation to resolve VUR, when present. Patients were followed at 6 month intervals until considered toilet-trained. Data was prospectively collected at time of service. Results There were 618 patients (79% female) referred after FUTI at median age 3.4 years. Of these, 149 (24%) had abnormal DMSA, in whom RBUS was normal in 66% and VUR was present in 76%. Follow up data was available in 602 children at mean of 1.7 years (5m-4y), with 119 (20%) developing recurrent FUTI. Risk factors for recurrent FUTI included abnormal DMSA (OR 2.5, 1.3-4.9), and ≥ 2 FUTI (OR 1.64, 1.3-2.1) before referral. Neither VUR nor VUR grade were independent risk factors for recurrent FUTI. Bowel/bladder dysfunction, diagnosed and managed in 61% of 505 toilet trained patients, also did not predict recurrent FUTI. Conclusions Abnormal delayed DMSA occurred in 24% of referred children after FUTI, despite a normal RBUS in 66%. Abnormal DMSA was a risk factor for recurrent FUTI, as was recurrent FUTI before referral. Although VUR is a risk factor for abnormal DMSA, it did not predict recurrent FUTI during follow up despite no treatment in those with normal DMSA. Top down imaging using DMSA ≥3 months after last FUTI identifies patients with renal damage, and those at risk for recurrent FUTI. Cystography can be reserved for patients with abnormal DMSA or with recurrent UTI despite normal DMSA. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e445 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Melise Keays More articles by this author Colby Adams More articles by this author Kimberly Mizener More articles by this author Karen Pritzker More articles by this author William Smith More articles by this author Janelle Traylor More articles by this author Carlos Villanueva More articles by this author Warren Snodgrass More articles by this author Nicol C. Bush More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...