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Reduced differential renal function in scintigraphy predicted high-grade vesicoureteral reflux in children with antenatal hydronephrosiss
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Pediatric Surgery. Univ Helsinki, Helsinki, Finland; Helsinki Univ Hosp, Dept Pediat Surg, Helsinki, Finland.
Univ Helsinki, Helsinki, Finland;Helsinki Univ Hosp, Dept Pediat Nephrol & Transplantat, Helsinki, Finland.
Helsinki Univ Hosp, Dept Pediat Radiol, Helsinki, Finland.
Helsinki Univ Hosp, Dept Pediat Surg, Helsinki, Finland.
2019 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, no 4, p. 751-756Article in journal (Refereed) Published
Abstract [en]

Aim: A top-down approach is widely used for detecting vesicoureteral reflux (VUR) in children with febrile urinary tract infections. We evaluated the diagnostic value of renal scintigraphy in predicting VUR in children with antenatal hydronephrosis (AHN).

Methods: The voiding cystourethrogram (VCUG) and renal scintigraphy results of 125 AHN patients (76% male) admitted to the Children's Hospital of Helsinki University, Finland, from 2003 to 2013 were analysed. Of those, 94 had nonrefluxing hydronephrosis, nine had low-grade VUR and 22 had high-grade VUR.

Results: Scintigraphy was performed at a median age of 1.4 (0.8-15.6) months. In patients with high-grade VUR, the differential renal function (DRF) of the worse kidney was significantly lower than in patients without VUR, with a median of 35% and interquartile range (IQR) of 20-45 versus 47% (IQR: 44-49), (p < 0.001). There was no difference between patients with low-grade VUR and patients without VUR (p = 0.181). DRFs below 44% showed a sensitivity of 73% and specificity of 79% and predicted significantly high-grade VUR (odds ratio 9.82, 95% confidence interval 3.44-28.05, p < 0.001) in the univariate analysis.

Conclusion: A DRF below 44% predicted high-grade VUR in patients with AHN and supported the decision to perform VCUG.

Place, publisher, year, edition, pages
WILEY , 2019. Vol. 108, no 4, p. 751-756
Keywords [en]
Antenatal diagnosis, Hydronephrosis, Infant, Scintigraphy, Vesicoureteral reflux
National Category
Pediatrics
Identifiers
URN: urn:nbn:se:uu:diva-380434DOI: 10.1111/apa.14536ISI: 000461014600027PubMedID: 30113092OAI: oai:DiVA.org:uu-380434DiVA, id: diva2:1300762
Available from: 2019-03-29 Created: 2019-03-29 Last updated: 2019-03-29Bibliographically approved

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