DMSA renal scan no replacement for VCUG in young children with first UTI

Acute-phase dimercaptosuccinic acid renal scanning should not replace voiding cystourethrography when evaluating infants and young children for a febrile urinary tract infection, according to a recent meta-analysis.

Researchers from Democritus University of Thrace, University General Hospital of Alexandroupolis, and the Alfa Institute of Biomedical Sciences, in Athens, Greece, analyzed 13 cohort studies, both patient-based and renal unit-based, of children with their first febrile UTI.

The researchers said the accuracy of dimercaptosuccinic acid (DMSA) renal scanning for identifying vesicoureteral reflux (VUR; grades 3-5) was “rather poor.” Specifically, the pooled specificity and sensitivity rates of DMSA were only 79% and 53%, respectively, for the patient-based analysis, and only 60% and 65%, respectively, for the renal unit-based analysis.

The researchers noted some limitations to the use of DMSA; specifically, its cost and the fact that it is time-consuming and requires IV use. The results of their findings back AAP recommendations to perform ultrasonography and dimercaptosuccinic acid (VCUG) alone in infants aged 2 to 24 months with UTI, they said.

“A selective approach that focuses on kidney involvement rather than VUR may select those children with reflux who are at greatest risk for renal scarring, therefore avoiding a sufficient number of VCUGs. Prospective cohort studies are needed to clarify the natural history of VUR in relation to scintigraphically confirmed renal scarring in both genders,” the researchers concluded.

Disclosure: The researchers reported no relevant financial disclosures.

Follow the PediatricSuperSite.com on Twitter.