Clinical value of late DMSA scan in predicting vesicoureteral reflux in children with febrile urinary tract infection

Abstract

Aim: To assess the usefulness of late dimercaptosuccinic acid (DMSA) renal scans in revealing high-grade vesicoureteral reflux(VUR).Material and Methods: Between July 2015 and December 2016, medical records of 112 patients who were admitted with febrileurinary tract infections (fUTIs) were retrospectively reviewed. The demographic information of the patients, and follow-up imaging[ultrasonography (USG), DMSA renal scans, and voiding cystourethrography] data were reviewed.Results: Of the 112 patients, 82 patients (73.2%) were female, 30 were male (26.8%), and the mean age was 7.04 ± 3.94 years.Recurrent fUTIs were detected in 65 patients (58%). Of the patients, 68 (60.7%) had abnormal urinary system USG, and 74 (66.1%)had abnormal DMSA renal scans. Vesicoureteral reflux (VUR) was detected in 63 patients (56.3%). VUR was present in 49 (66.2%) of74 patients with scarring in DMSA and detected in 14 (38.8%) of 38 patients with normal DMSA scans. Significant agreement (kappa:0.274 / p=0.003) was found between DMSA and VUR results. The sensitivity, specificity and positive predictive values of late DMSArenal scan to predict VUR were 77.8 %, 49 % and 63.2% respectively.Conclusion: Abnormal late DMSA scans carry a higher sensitivity and positive predictive value for predicting high-grade VUR inchildren with recurrent fUTIs. Late DMSA imaging seems a useful option in screening for high-grade VUR in children when the acuteinterventions are limited.