Kidney imaging in management of delayed febrile urinary tract infection

We report a cross-sectional study performed to evaluate the imaging findings of 40 children,aged one month to five years (16.65 ± 14.97 months),who presented with protracted fever of more than 48 hours due to urinary tract infection (UTI). About 85% of the patients had positive Tc99-Dimercaptosuccinic acid (DMSA) scan and 58% had vesicoureteral reflux (VUR). Kidney sonography aided in the diagnosis and treatment in 10% of the patients. Age,sex,presence or laterality of VUR did not contribute to defective DMSA scan (pyelonephritis) (P 0.05). Delayed diagnosis and treatment of febrile UTI is associated with a high incidence of positive findings of DMSA scan irrespective of age,sex or presence/absence of VUR. In mild VUR,the DMSA scan may be normal while in patients with moderate and severe VUR the DMSA scan is almost always abnormal. Thus,our study shows that a normal DMSA scan can help in ruling out moderate to severe forms of VUR and that cystography remains an excellent and standard tool for the diagnosis of VUR.