PMID- 14501662
OWN - NLM
STAT- MEDLINE
DCOM- 20031015
LR  - 20170908
IS  - 0022-5347 (Print)
IS  - 0022-5347 (Linking)
VI  - 170
IP  - 4 Pt 2
DP  - 2003 Oct
TI  - Incidence of new renal parenchymal inflammatory changes following breakthrough 
      urinary tract infection in patients with vesicoureteral reflux treated with 
      antibiotic prophylaxis: evaluation by 99MTechnetium dimercapto-succinic acid 
      renal scan.
PG  - 1566-8; discussion 1568-9
AB  - PURPOSE: Breakthrough urinary tract infections (UTI) are considered an indication 
      for surgical intervention in children with vesicoureteral reflux (VUR) with the 
      goal of preventing new or progressive renal scarring. We assessed the incidence 
      of new renal parenchymal inflammatory changes following breakthrough UTI in 
      patients on antibiotic prophylaxis for VUR. MATERIALS AND METHODS: We 
      prospectively analyzed 38 patients (62 refluxing renal units) with VUR. All 
      patients experienced a culture documented breakthrough UTI (greater than 100,000 
      cfu/ml) while taking antibiotic prophylaxis. Dimercapto-succinic acid (DMSA) 
      scans were obtained 4 to 6 weeks after UTI to detect new renal inflammatory 
      changes and all scans were reviewed by the same pediatric nuclear medicine 
      specialist (MM). To avoid misinterpretation of preexistent renal scarring for 
      acute inflammation, new pyelonephritis was confirmed by comparison to prior DMSA 
      scan. RESULTS: Of 38 patients 14 (38%) had preexistent renal scarring but only 1 
      (7%) manifested new changes on DMSA scan. Of the remaining 24 patients with 
      normal baseline studies 3 (12.5%) had changes after UTI. Overall, only 4 patients 
      (10.5%) manifested new changes on DMSA scan. Three additional patients who did 
      not have a baseline scan for comparison demonstrated unequivocal changes of acute 
      pyelonephritis on DMSA scan, increasing the incidence to 17% (7 of 41). Of the 
      patients 7 (17%) underwent surgical correction of reflux and 34 (83%) were 
      maintained on antibiotic prophylaxis. CONCLUSIONS: Of patients with VUR who 
      experienced a single breakthrough UTI while on antibiotic prophylaxis, at most 
      only 17% had renal inflammatory changes on acute DMSA scan. Our findings endorse 
      the usefulness of DMSA scan in tailoring management of VUR and breakthrough UTI 
      cases, and lend support to continued nonoperative management for the majority.
FAU - Szlyk, Gregory R
AU  - Szlyk GR
AD  - Department of Pediatriic Urology, Children's National Medical Center andd the 
      George Washington Univeristy Medical Center, Washington, DC 20010, USA.
FAU - Williams, Stephen B
AU  - Williams SB
FAU - Majd, Massoud
AU  - Majd M
FAU - Belman, A Barry
AU  - Belman AB
FAU - Rushton, H Gil
AU  - Rushton HG
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Urol
JT  - The Journal of urology
JID - 0376374
RN  - 494JNQ8L28 (Technetium Tc 99m Dimercaptosuccinic Acid)
SB  - IM
MH  - *Antibiotic Prophylaxis
MH  - Child
MH  - Cicatrix/diagnostic imaging
MH  - Combined Modality Therapy
MH  - Female
MH  - Humans
MH  - Male
MH  - Prospective Studies
MH  - Pyelonephritis/*diagnostic imaging/drug therapy
MH  - *Radioisotope Renography
MH  - Recurrence
MH  - Retreatment
MH  - Technetium Tc 99m Dimercaptosuccinic Acid
MH  - Treatment Outcome
MH  - Vesico-Ureteral Reflux/*diagnostic imaging/drug therapy/surgery
EDAT- 2003/09/23 05:00
MHDA- 2003/10/16 05:00
CRDT- 2003/09/23 05:00
PHST- 2003/09/23 05:00 [pubmed]
PHST- 2003/10/16 05:00 [medline]
PHST- 2003/09/23 05:00 [entrez]
AID - S0022-5347(05)63063-7 [pii]
AID - 10.1097/01.ju.0000085962.68246.ce [doi]
PST - ppublish
SO  - J Urol. 2003 Oct;170(4 Pt 2):1566-8; discussion 1568-9. doi: 
      10.1097/01.ju.0000085962.68246.ce.