Investig Clin Urol.  2017 Jun;58(Suppl 1):S23-S31. 10.4111/icu.2017.58.S1.S23.

Imaging studies and biomarkers to detect clinically meaningful vesicoureteral reflux

• Prasad MM
• Cheng EY

• KMID: 2379892
• DOI: http://doi.org/10.4111/icu.2017.58.S1.S23

Abstract

The work-up of a febrile urinary tract infection is generally performed to detect vesicoureteral reflux (VUR) and its possible complications. The imaging modalities most commonly used for this purpose are renal-bladder ultrasound, voiding cystourethrogram and dimercapto-succinic acid scan. These studies each contribute valuable information, but carry individual benefits and limitations that may impact their efficacy. Biochemical markers are not commonly used in pediatric urology to diagnose or differentiate high-risk disease, but this is the emerging frontier, which will hopefully change our approach to VUR in the future. As it becomes more apparent that there is tremendous clinical variation within grades of VUR, the need to distinguish clinically significant from insignificant disease grows. The unfortunate truth about VUR is that recommendations for treatment may be inconsistent. Nuances in clinical decision-making will always exist, but opinions for medical versus surgical intervention should be more standardized, based on risk of injury to the kidney.

Keyword

Biomarkers; Technetium Tc 99m dimercaptosuccinic acid; Urinary tract infections; Urography; Vesicoureteral reflux

MeSH Terms

Biomarkers*
Clinical Decision-Making
Kidney
Technetium Tc 99m Dimercaptosuccinic Acid
Ultrasonography
Urinary Tract Infections
Urography
Urology
Vesico-Ureteral Reflux*
Biomarkers
Technetium Tc 99m Dimercaptosuccinic Acid

Figure

• 

  Fig. 1 Graphical representation of the top-down versus bottom-up approach to the work-up of a febrile urinary tract infection (FUTI). DMSA, dimercapto-succinic acid scan; VCUG, voiding cystourethrogram; RBUS, renal-bladder ultrasound; VUR, vesicoureteral reflux. The “+” symbol indicates that the study had a significant finding. The “−” symbol indicates that the study was normal.

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