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Ahn, Jeong, and Lee: Comparative Analysis between Top-Down and Down-Top Approach in Children with Febrile Urinary Tract Infection
Original Article

Korean J Urogenit Tract Infect Inflamm 2013;8(1):38-42.

Published online: 17 April 2013

DOI: https://doi.org/10.14777/kjutii.2013.8.1.38

Comparative Analysis between Top-Down and Down-Top Approach in Children with Febrile Urinary Tract Infection

Jae Hyun Ahn, Seung Chan Jeong, Sang Don Lee

Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea

Correspondence to: Sang Don Lee, Department of Urology, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eup, Yangsan 626-787, Korea Tel: +82-55-360-2134, Fax: +82-55-360-2164 E-mail: lsd@pusan.ac.kr

This work was supported for 1 years by Pusan National University Yangsan Hospital Research Grant. No potential conflict of interest relevant to this article was reported.

Received 4 April 2013       Revised 13 April 2013       Accepted 13 April 2013

Copyright © 2013 Korean Association of Urogenital Tract Infection and Inflammation

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Vesicoureteral reflux, Child, Urinary tract infections

REFERENCES

1. Rushton HG. Urinary tract infections in children. Epidemiology, evaluation, and management. Pediatr Clin North Am. 1997; 44:1133–69.
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8. Stokland E, Hellstrom M, Jacobsson B, Jodal U, Lundgren P, Sixt R. Early 99mTc dimercaptosuccinic acid (DMSA) scintigraphy in symptomatic first-time urinary tract infection. Acta Paediatr. 1996; 85:430–6.
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Table 1.
Patients’ characteristics
  No. of patients Mean age (month)
Total 42 30.3±33.2
Boy 25 21.2±30.0
Girl 17 43.7±34.2
<1 year 18 6.8±2.5
>1 year 24 48.0±34.7
Table 2.
Results of VCUG and DMSA scan in patients with febrile urinary tract infection (N=42)
Group I VUR (22 pts.) Abnormal DMSA (14pts.) High grade (11 pts.)
  Normal DMSA (8 pts.) Low grade (3 pts.) High grade (2 pts.)
    Low grade (6 pts.)
No VUR (20 pts.) Abnormal DMSA (4 pts.) -
  Normal DMSA (16 pts.) -
Group II    
Abnormal DMSA (18 pts.) VUR (14 pts.) High grade (11 pts.)
  No VUR (4 pts.) Low grade (3 pts.) -
  No VUR (4 pts.) -
Normal DMSA (24 pts.) VUR (8 pts.) High grade (2 pts.) Low grade (6 pts.)
    Low grade (6 pts.)
  No VUR (16 pts.) -

VCUG: voiding cystourethrography, DMSA: dimercaptosuccinic acid, VUR vesicoureteral reflux.

Table 3.
Detection rates of VUR according to approach method children with febrile urinary tract infection
  Detection rate of VUR (%) p-value
Total (N=42)    
 Group I 22/42 (52.4) 0.078
 Group II 14/42 (33.3)
 High grade VUR (group I) 13/42 (31.0) 0.629
 High grade VUR (group II) 11/42 (26.2)
Boys (N=25)    
 Group I 14/25 (56.0) 0.156
 Group II 9/25 (36.0)
 High grade VUR (group I) 7/25 (28.0) 0.747
 High grade VUR (group II) 6/25 (24.0)
Girls (N=17)    
 Group I 8/17 (47.1) 0.290
 Group II 5/17 (29.4)
 High grade VUR (group I) 6/17 (35.3) 0.714
 High grade VUR (group II) 5/17 (29.4)
<1 year (N=18)    
 Group I 7/18 (38.9) 0.041∗
 Group II 3/18 (16.7)
 High grade VUR (group I) 3/18 (16.7) 0.189
 High grade VUR (group II) 2/18 (11.1)
>1 year (N=24)    
 Group I 15/24 (62.5) 0.247
 Group II 11/24 (45.8)
 High grade VUR (group I) 10/24 (41.7) 0.768
 High grade VUR (group II) 9/24 (37.5)

VUR: vesicoureteral reflux.

∗ p<0.05.

Table 4.
Specificity, sensitivity, and positivie prediction rate of DMSA scan in children with VUR
  Specificity (%) Sensitivity (%) Positive prediction rate (%)
Total (N=42) 14/22 (63.6) 16/20 (80.0) 14/18 (77.8)
 High grade VUR 11/13 (84.6) 16/20 (80.0) 11/15 (73.3)
Boys (N=25) 9/14 (64.3) 8/11 (72.7) 9/12 (75.0)
 High grade VUR 6/7 (85.7) 8/11 (72.7) 6/9 (66.6)
Girls (N=17) 5/8 (62.5) 8/9 (88.9) 5/6 (83.3)
 High grade VUR 5/6 (83.3) 8/9 (88.9) 5/6 (83.3)
<1 year (N=18) 3/7 (42.9) 10/11 (90.1) 3/4 (75.0)
 High grade VUR 2/3 (66.7) 10/11 (90.1) 2/3 (66.7)
>1 year (N=24) 11/15 (73.3) 6/9 (66.7) 11/14 (78.6)
 High grade VUR 9/10 (90.0) 6/9 (66.7) 9/12 (75.0)
<1 year boys (N=15) ) 3/7 (42.9) 7/8 (82.5) 3/4 (75.0)
 High grade VUR 2/3 (66.7) 7/8 (82.5) 2/3 (66.7)
<1 year girls (N=3) - - -
 High grade VUR - - -
>1 year boys (N=10) ) 6/7 (85.7) 1/3 (33.3) 6/8 (75.0)
 High grade VUR 4/4 (100) 1/3 (33.3) 4/6 (66.7)
>1 year girls (N=14) 5/8 (62.5) 5/6 (83.3) 5/6 (83.3)
 High grade VUR 5/6 (83.3) 5/6 (83.3) 5/6 (83.3)

DMSA: dimercaptosuccinic acid, VUR: vesicoureteral reflux.

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