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

Gregory R. Szlyk, Stephen Williams, Massoud Majd, A. Barry Belman, H. Gil Rushton

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1566-1568
Number of pages3
JournalJournal of Urology
Volume170
Issue number4 II
DOIs
StatePublished - Oct 1 2003
Externally publishedYes

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Vesico-Ureteral Reflux
Antibiotic Prophylaxis
Succinic Acid
Urinary Tract Infections
Kidney
Incidence
Cicatrix
Pyelonephritis
Nuclear Medicine
Pediatrics
Inflammation

Keywords

  • Inflammation
  • Urinary tract infections
  • Vesico-ureteral reflux

ASJC Scopus subject areas

  • Urology

Cite this

@article{50c9a9e3631b402f9bbcb5089be902fc,
title = "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",
abstract = "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.",
keywords = "Inflammation, Urinary tract infections, Vesico-ureteral reflux",
author = "Szlyk, {Gregory R.} and Stephen Williams and Massoud Majd and Belman, {A. Barry} and Rushton, {H. Gil}",
year = "2003",
month = "10",
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doi = "10.1097/01.ju.0000085962.68246.ce",
language = "English (US)",
volume = "170",
pages = "1566--1568",
journal = "Journal of Urology",
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TY - JOUR

T1 - Incidence of new renal parenchymal inflammatory changes following breakthrough urinary tract infection in patients with vesicoureteral reflux treated with antibiotic prophylaxis

T2 - Evaluation by 99Mtechnetium dimercapto-succinic acid renal scan

AU - Szlyk, Gregory R.

AU - Williams, Stephen

AU - Majd, Massoud

AU - Belman, A. Barry

AU - Rushton, H. Gil

PY - 2003/10/1

Y1 - 2003/10/1

N2 - 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.

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.

KW - Inflammation

KW - Urinary tract infections

KW - Vesico-ureteral reflux

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