title: [Imaging studies in the first urinary infection with fever in infants: is voiding cystourethrography necessary?].
abstract: BACKGROUND
  The presence of vesicoureteral reflux (VUR) in an infant with urinary tract infection (UTI), does not necessarily lead to an acquired renal injury. Only serious reflux can be a factor in fostering its appearance.
  
  
  OBJECTIVE
  To assess whether in infants diagnosed for the first time with a UTI with a fever, a routine initial DMSA can be used as a screening method for detecting severe reflux and replace voiding cystourethrography (VCUG).
  
  
  METHODS
  We retrospectively studied 162 infants under 2 years old admitted to our hospital due to having a ITU with fever for the first time (92 males and 70 females). In all cases, a renal ultrasound, DMSA and VCUG had been performed a few days after the diagnosis.
  
  
  RESULTS
  Of the 162 patients, 62 (38 %) had VUR, of which 56 (90 %) were mild and 6 (10 %) were severe. The DMSA was abnormal in 26/100 patients without VUR (26 %), 12/56 with mild VUR (21 %) and 6/6 of those with severe VUR (100 %). DMSA sensitivity for detecting severe reflux was 100 % and specificity was 76 %. The positive predictive value and negative predictive value was 14 % and 100 % respectively. The positive likelihood ratio was 4.17 and the negative likelihood ratio was 0.
  
  
  CONCLUSIONS
  It is unnecessary to carry out VCUG in an infant with an initial UTI, and a negative DMSA.
authors.affiliation: Servicio de Pediatría, Hospital Donostia, San Sebastián, Guipúzcoa, España.
authors.forename: O
authors.initials: O
authors.lastname: Muga Zuriarrain
authors.forename: E
authors.initials: E
authors.lastname: Oñate Vergara
authors.forename: I
authors.initials: I
authors.lastname: Sota Busselo
authors.forename: D
authors.initials: D
authors.lastname: Arruebarrena Lizarraga
authors.forename: M
authors.initials: M
authors.lastname: Ubetagoyena Arrieta
authors.forename: C
authors.initials: C
authors.lastname: García Pardos
authors.forename: J I
authors.initials: JI
authors.lastname: Emparanza Knörr
authors.forename: R
authors.initials: R
authors.lastname: Areses Trapote
mesh_terms: D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D007223:Infant; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D014521:Urethra / Q000000981:diagnostic imaging; D001743:Urinary Bladder / Q000000981:diagnostic imaging; D014552:Urinary Tract Infections / Q000150:complications / Q000000981:diagnostic imaging*; D014554:Urination