title: Value of imaging studies after a first febrile urinary tract infection in young children: data from Italian renal infection study 1.
abstract: OBJECTIVE
  We examined the diagnostic accuracy of routine imaging studies (ultrasonography and micturating cystography) for predicting long-term parenchymal renal damage after a first febrile urinary tract infection.
  
  
  METHODS
  This study addressed the secondary objective of a prospective trial evaluating different antibiotic regimens for the treatment of acute pyelonephritis. Data for 300 children < or =2 years of age, with normal prenatal ultrasound results, who completed the diagnostic follow-up evaluation (ultrasonography and technetium-99m-dimercaptosuccinic acid scanning within 10 days, cystography within 2 months, and repeat technetium-99m-dimercaptosuccinic acid scanning at 12 months to detect scarring) were analyzed. Outcome measures were sensitivity, specificity, and negative and positive predictive values for ultrasonography and cystography in predicting parenchymal renal damage on the 12-month technetium-99m-dimercaptosuccinic acid scans.
  
  
  RESULTS
  The kidneys and urinary tracts were mostly normal. The acute technetium-99m-dimercaptosuccinic acid scans showed pyelonephritis in 54% of cases. Renal scarring developed in 15% of cases. The ultrasonographic and cystographic findings were poor predictors of long-term damage, showing minor sonographic abnormalities for 12 and reflux for 23 of the 45 children who subsequently developed scarring.
  
  
  CONCLUSIONS
  The benefit of performing ultrasonography and scintigraphy in the acute phase or cystourethrography is minimal. Our findings support (1) technetium-99m-dimercaptosuccinic acid scintigraphy 6 months after infection to detect scarring that may be related to long-term hypertension, proteinuria, and renal function impairment (although the degree of scarring was generally minor and did not impair renal function) and (2) continued surveillance to identify recurrent urinary tract infections that may warrant further investigation.
authors.affiliation: Departments of Pediatric Nephrology, University of Padua, Padua, Italy. montini@pediatria.unipd.it
authors.forename: Giovanni
authors.initials: G
authors.lastname: Montini
authors.forename: Pietro
authors.initials: P
authors.lastname: Zucchetta
authors.forename: Lisanna
authors.initials: L
authors.lastname: Tomasi
authors.forename: Enrico
authors.initials: E
authors.lastname: Talenti
authors.forename: Waifro
authors.initials: W
authors.lastname: Rigamonti
authors.forename: Giorgio
authors.initials: G
authors.lastname: Picco
authors.forename: Alberto
authors.initials: A
authors.lastname: Ballan
authors.forename: Andrea
authors.initials: A
authors.lastname: Zucchini
authors.forename: Laura
authors.initials: L
authors.lastname: Serra
authors.forename: Vanna
authors.initials: V
authors.lastname: Canella
authors.forename: Marta
authors.initials: M
authors.lastname: Gheno
authors.forename: Andrea
authors.initials: A
authors.lastname: Venturoli
authors.forename: Marco
authors.initials: M
authors.lastname: Ranieri
authors.forename: Valeria
authors.initials: V
authors.lastname: Caddia
authors.forename: Carla
authors.initials: C
authors.lastname: Carasi
authors.forename: Roberto
authors.initials: R
authors.lastname: Dall'amico
authors.forename: Ian
authors.initials: I
authors.lastname: Hewitt
mesh_terms: D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D007223:Infant; D007558:Italy; D007674:Kidney Diseases / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011859:Radiography; D011877:Radionuclide Imaging; D015203:Reproducibility of Results; D014463:Ultrasonography; D014552:Urinary Tract Infections / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy