DIAGNOSTIC MODALITIES OF CHILDHOOD URINARY TRACT INFECTION: CLINICAL VERSUS IMAGING

Seventy six infants and children with febrile urinary tract infection ( UTI) were stud-ied aiming at investigating the most reliable i ~ n q i n g approach for febrile UTI and to evaluate the reliability of clinical and laboratory diagnosis of acute pyelonephritis (APN) versus intaging diagnosis using renal scan with dirnercaptosuccinic acid labeled with technetium 991n (99mTc-DMSA) as stmdard reference. Positive radiological findings were documented in 36 out of the 76 studied patients (47.37%). Out of the 76 studiedpa-tients APN was confir~ned in 28patienb (36.84%) by 991nTc-DMSA scanning. Renal 111-rasonography (US) detected upper urinary tract abnormnlities in 19.74 % (15176) of pa-tients, all of them had DMSA positive scan for APN. Micturating cystourethrography (MCUG) demonstrated vesicoureteral reflux (VUR) in 23.68 % (18/76) patients. Positive DMSA scan for APN was documented in 61.11 % (11/18) of patients with VUR. The sensitivity of US co~npared to 99nzTc-DMSA scan for detection of acute renalpa-renchy~ml changes was 53.57%, the specifici & was 100 % and the accuracy was 76.79%. Co~npared to 991nTc-DMSA scan, clinical and laboratory diagnosis of APN had a sensi-tivity of 67.85%, specificii of 72.92 % and accuracy of 70.39%. In conclusion: the diag-nosis of APN among infants and children with febrile UTI based on clinical and Inbora-tory observations is insufficient and requires i~naging studies. The three imaging ~nodalities chosen are co~nplernentary and are needed for establishing a diagnostic ap-proach for childhood UTI. The results of this study also e~nphasize the value of 99mTc-DMSA scintigraphy in the initial evaluation of febrile UTI