title: Identifying children with vesicoureteral reflux: a comparison of 2 approaches.
abstract: OBJECTIVE
  Various screening approaches have been proposed to identify the subgroup of children with urinary tract infection who have vesicoureteral reflux. However, few studies have compared the sensitivity of screening approaches in a representative population of young children. We compared the sensitivities of the top-down ((99m)technetium dimercaptosuccinic acid renal scan to screen) and biomarker based (C-reactive protein level at presentation) approaches in identifying children with vesicoureteral reflux.
  
  
  METHODS
  We calculated the sensitivity of the 2 screening approaches in detecting vesicoureteral reflux and subsequently high grade (III or greater) vesicoureteral reflux in children.
  
  
  RESULTS
  The top-down and C-reactive protein based approaches missed 33% and 29% of cases of high grade vesicoureteral reflux, respectively.
  
  
  CONCLUSIONS
  The sensitivity of the top-down approach for detecting high grade vesicoureteral reflux was lower than previously reported. Further study of novel methods to identify children at risk for renal scarring is warranted.
authors.affiliation: Division of General Academic Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15224, USA.
authors.forename: Nader
authors.initials: N
authors.lastname: Shaikh
authors.forename: Alejandro
authors.initials: A
authors.lastname: Hoberman
authors.forename: Howard E
authors.initials: HE
authors.lastname: Rockette
authors.forename: Marcia
authors.initials: M
authors.lastname: Kurs-Lasky
mesh_terms: D002097:C-Reactive Protein / Q000032:analysis*; D003950:Diagnostic Techniques, Urological; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D014718:Vesico-Ureteral Reflux / Q000097:blood* / Q000000981:diagnostic imaging*
chemical_list: D019275:Radiopharmaceuticals; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D002097:C-Reactive Protein