열성요로감염 환아에서 Top-Down 접근과 Down-Top 접근의 비교분석
Comparative Analysis between Top-Down and Down-Top Approach in Children with Febrile Urinary Tract Infection
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: We performed a comparative analysis of the usefulness of top-down and down-top approach in children with febrile urinary tract infection (UTI). Materials and Methods: Among 79 children, 42 children had undergone voiding cystourethrography (VCUG) and dimercaptosuccinic acid (DMSA) scintigraphy. High grade vesicoureteral reflux (VUR) was defined as grade VI and V. We analyzed the detection rate of VUR between down-top (group I) and top-down approach (group II). Results: The mean age of 42 children (Boys 25, girls 17) was 30.3±33.2 years. Among 42 children, 22 (52.4%) were diagnosed as VUR. Detection rate of VUR in groups I and II was 52.4% and 33.3%, respectively (p=0.078). Detection rate of VUR according to sex and age was 56.0% and 36.0% in boys (p=0.156), 47.1% and 29.4% in girls (p=0.290), and 38.9% and 16.7% in children younger than one year of age (p=0.041), and 62.5% and 45.8% in children older than one year of age (p=0.247), respectively. In high grade VUR, there was a similar detection rate of VUR, regardless of sex or age. Sensitivity, specificity, and positive prediction rate of DMSA scintigraphy in all patients and children with high grade VUR were 63.6%, 80.0%, 77.8%, and 84.6%, 80.0%, 73.3%, respectively. Conclusions: In children with febrile UTI who were younger one year of age, down-top approach was more useful for diagnosis of VUR. Therefore, VCUG may initially be needed for diagnosis of VUR in children with febrile UTI who were younger than one year of age.
Abstract
Purpose: We performed a comparative analysis of the usefulness of top-down and down-top approach in children with febrile urinary tract infection (UTI). Materials and Methods: Among 79 children, 42 children had undergone voiding cystourethrography (VCUG) and dimercaptosuccinic acid (DMSA) scintigraphy. High grade vesicoureteral reflux (VUR) was defined as grade VI and V. We analyzed the detection rate of VUR between down-top (group I) and top-down approach (group II). Results: The mean age of 42 children (Boys 25, girls 17) was 30.3±33.2 years. Among 42 children, 22 (52.4%) were diagnosed as VUR. Detection rate of VUR in groups I and II was 52.4% and 33.3%, respectively (p=0.078). Detection rate of VUR according to sex and age was 56.0% and 36.0% in boys (p=0.156), 47.1% and 29.4% in girls (p=0.290), and 38.9% and 16.7% in children younger than one year of age (p=0.041), and 62.5% and 45.8% in children older than one year of age (p=0.247), respectively. In high grade VUR, there was a similar detection rate of VUR, regardless of sex or age. Sensitivity, specificity, and positive prediction rate of DMSA scintigraphy in all patients and children with high grade VUR were 63.6%, 80.0%, 77.8%, and 84.6%, 80.0%, 73.3%, respectively. Conclusions: In children with febrile UTI who were younger one year of age, down-top approach was more useful for diagnosis of VUR. Therefore, VCUG may initially be needed for diagnosis of VUR in children with febrile UTI who were younger than one year of age.
참고문헌 (10)
- Rushton HG., "Urinary tract infections in children. Epidemiology, evaluation, and management", Pediatr Clin North Am, 44, pp.1133~1169 (1997)
- Technical report: urinary tract infections in febrile infants and young children. The Urinary Tract Subcommittee of the American Academy of Pediatrics Committee on Quality Improvement, "Downs SM", Pediatrics, 103~, pp.e54 (1999)
- Lebowitz RL, "International system of radiographic grading of vesicoureteric reflux. International Reflux Study in Children", Pediatr Radiol, 15, pp.105~109 (1985)
- Committee on Quality Improvement. Subcommittee on Urinary Tract Infection, "Practice parameter: the diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children", Pediatrics, 103, pp.843~852 (1999)
- Hoberman A, "Imaging studies after a first febrile urinary tract infection in young children", N Engl J Med, 348, pp.195~202 (2003)
- Hitzel A, "Color and power Doppler sonography versus DMSA scintigraphy in acute pyelonephritis and in prediction of renal scarring", J Nucl Med, 43, pp.27~32 (2002)
- Lee JH, "Is a routine voiding cystourethrogram necessary in children after the first febrile urinary tract infection?", Acta Paediatr, 101, pp.e105~109 (2012)
- Stokland E, "Early 99mTc dimercaptosuccinic acid (DMSA) scintigraphy in symptomatic first-time urinary tract infection", Acta Paediatr, 85, pp.430~436 (1996)
- Caione P, "Renal damage in vesico-ureteric reflux", BJU Int, 93, pp.591~595 (2004)
- Supavekin S, "The role of DMSA renal scintigraphy in the first episode of urinary tract infection in childhood", Ann Nucl Med, 27, pp.170~176 (2013)