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Neonatal Urinary Tract Infection Prognosis Difficult

Last Updated: August 03, 2009.

Renal scintigraphy of young infants with urinary tract infections can help rule out permanent renal damage, but catheterization to perform voiding cystourethrography may still be required to detect congenital defects such as dilating vesicoureteral reflux, according to a study published online Aug. 3 in Pediatrics.

MONDAY, Aug. 3 (HealthDay News) -- Renal scintigraphy of young infants with urinary tract infections (UTIs) can help rule out permanent renal damage, but catheterization to perform voiding cystourethrography may still be required to detect congenital defects such as dilating vesicoureteral reflux, according to a study published online Aug. 3 in Pediatrics.

Ekaterini Siomou, M.D., of the University Hospital of Ioannina in Greece, and colleagues enrolled 72 28-day-old or younger infants with UTIs in a study to determine if a normal scintigraphic imaging predicts the absence of vesicoureteral reflux and low risk for permanent renal damage. The infants underwent technetium-99m-labeled dimercaptosuccinic acid (DMSA) scintigraphy within 72 hours of UTI diagnosis and voiding cystourethrography within one to two months. DMSA scintigraphy was performed again six months after UTI to assess permanent renal damage.

The researchers found that 71 percent of the renal units with vesicoureteral reflux had normal early DMSA scintigraphic results, giving the imaging modality a 29 percent sensitivity and an 82 percent specificity for predicting vesicoureteral reflux. Permanent renal damage was diagnosed in 7 percent of the renal units, all of which had abnormal early DMSA scintigraphic results. Permanent renal damage was significantly more frequent among renal units with vesicoureteral reflux than those without it.

"Normal early DMSA scintigraphic results for neonates with symptomatic UTIs were helpful in ruling out later development of permanent renal damage but were not predictive of the absence of dilating vesicoureteral reflux. To rule out dilating vesicoureteral reflux, voiding cystourethrography may be required," the authors conclude.

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