984 Comparison of Dmsa Renal Scintigraphy and Micturating Cystouretrography in Children with Urinary Tract Infection

Background and aim: The relationship among urinary tract infection (UTI), vesicoureteral reflux (VUR) and permanent renal damage in children is not fully understood. We aimed to determine the change in probability of permanent renal damage due to the presence of VUR. Patients and Methods: 201 children with UTI, referred for dimercatpo-succinic renal scintigraphy (DMSA) 4-6 months after acute UTI. Micturating cystoureterography (MCU) was one month prior to DMSA. Likelihood ratio (LR) positive and negative, diagnostic odds ratio (DOR) and post test probability of (no) disease were calculated for VUR on MCU versus scarring on DMSA. Results: VUR was found in 118 patients. Of the 201 patients 55 (27.4 %) had permanent renal damage according to DMSA. Scarring was shown in 34.7% of patients with UTI and VUR and in 16.9% patients with UTI without VUR (p =0.005). LR positive was 1.274 (95% CI; 1.082, 1.500), LR negative (0.49, 95% CI: 0.28, 0.83) and DOR was 2.624 (95% CI; 1.319, 5.223). Rate of scarring significantly increased with VUR of grade III, IV and V. There was no significant difference in the incidence of scarring in children with UTI without VUR and children with low grade VUR (p=0.292). Presence of VUR on MCU increased the chance of renal damage on DMSA by about 13%, whereas the negative MCU increased the chance of no renal involvement by 8%. Conclusion: MCUG should not be used as a first line test to rule out the permanent renal damage due to UTI.