A scoring system for predicting downgrading and resolution of high-grade infant vesicoureteral reflux.

Aim: Aim of the study was to provide a scoring system for predicting downgrading and resolution of infantile high-grade vesicoureteral reflux (VUR).

Methods: Eighty-nine infants (65 boys) with high-grade VUR (grade 4-5) diagnosed at median age 2.5 months and followed to 39 months had repeated investigations of VUR grade, renal damage/function and bladder function.

Changes in differential renal function after pyeloplasty in infants and children.

Introduction: Ureteropelvic junction obstruction (UPJO) is one of the most common causes of hydronephrosis in pediatric populations. Many need surgical intervention. The aim of surgery is preserving renal function and reducing symptoms such as urinary tract infections and pain.

Urinary tract infection in small children: the evolution of renal damage over time.

Background: Our objective was to analyze the evolution of kidney damage over time in small children with urinary tract infection (UTI) and factors associated with progression of renal damage.

Methods: From a cohort of 1003 children <2 years of age with first-time UTI, a retrospective analysis of 103 children was done. Children were selected because of renal damage at index Tc-dimercaptosuccinic acid (DMSA) scintigraphy at least 3 months after UTI, and a late DMSA scan was performed after at least 2 years.

The Swedish infant high-grade reflux trial: UTI and renal damage.

Introduction: High-grade vesicoureteral reflux (VUR) in children is associated with recurrent urinary tract infection (UTI) and renal damage. Breakthrough UTI despite continuous antibiotic prophylaxis (CAP) during the first years of life is a matter of concern and evokes early intervention. We investigated whether early endoscopic treatment (ET) of VUR grade 4-5 can reduce the risk of UTI recurrence and renal scarring.

The Swedish infant high-grade reflux trial: Study presentation and vesicoureteral reflux outcome.

Introduction: High-grade vesicoureteral reflux (VUR) in infants is associated with congenital renal abnormalities, recurrent UTI, and bladder dysfunction. Endoscopic treatment (ET) is a well-established method in children with low to moderate reflux grades, but there is a lack of randomised controlled trials regarding the use of ET versus continuous antibiotic prophylaxis in infants with high-grade VUR.

Objective: This study aimed to determine whether high-grade VUR in infants can be treated with endoscopic injection and whether ET is superior to antibiotic prophylaxis in the treatment of VUR.

Urinary tract infection in infants: the significance of low bacterial count.

Background: In national guidelines for urinary tract infection (UTI) in children, different cut-off levels for defining bacteriuria are used. In this study, the relationship between bacterial count in infant UTI and inflammatory parameters, frequency of vesicoureteral reflux (VUR), kidney damage, and recurrent UTI was analyzed.

Methods: We conducted a population-based retrospective study of 430 infants age <1 year with symptomatic UTI diagnosed by suprapubic aspiration.

Renal function in adult women with urinary tract infection in childhood.

Background: The risk of deterioration of renal function in patients with urinary tract infection (UTI)-associated renal damage over several decades is incompletely known but of importance in regard to follow-up.

Methods: A population-based cohort of women followed from their first UTI in childhood was studied at median age of 27 years and now at 41 years. Renal damage was evaluated by (99m)Tc-dimercaptosuccinic acid scan and glomerular filtration rate (GFR) by (51)Cr-edetic acid clearance.

Twenty-four-hour ambulatory blood pressure in adult women with urinary tract infection in childhood.

Objective: To study 24-h ambulatory blood pressure (BP) and development of hypertension over four decades in women with childhood urinary tract infection (UTI) associated with renal damage.

Methods: A population-based group of 111 women was followed from their first UTI in childhood. The cohort was investigated at a median age of 27 years using standardized office BP measurement and was reinvestigated 15 years later with 24-h ambulatory BP monitoring (ABPM) and Tc-dimercaptosuccinic acid scan for evaluation of renal damage.

Guidelines for standard and diuretic renogram in children.

Special consideration needs to be given to children who undergo dynamic renography. The Paediatric Committee of the European Association of Nuclear Medicine has updated the previous guidelines. Details are provided on how to manage the child, the equipment, and the acquisition and processing protocols.

Ultrasonography and renography to visualize upper urinary tract in children with meningomyelocele - a prospective study.

Objective: Ultrasonography (US) is commonly used to visualize the upper urinary tract in children and adolescents with meningomyelocele (MMC). The aim of this investigation was to prospectively evaluate US in those with spinal angulation or obesity and compare it to the corresponding results obtained by mercaptoacetyltriglycine renography.

Patients And Methods: Twenty-five children and adolescents with MMC and pronounced angulation of the spine or obesity, were prospectively investigated with both US and renography during the period 2006 to 2008.

Imaging strategy for infants with urinary tract infection: a new algorithm.

Purpose: We analyzed clinical data for prediction of permanent renal damage in infants with first time urinary tract infection.

Materials And Methods: This population based, prospective, 3-year study included 161 male and 129 female consecutive infants with first time urinary tract infection. Ultrasonography and dimercapto-succinic acid scintigraphy were performed as acute investigations and voiding cystourethrography within 2 months.

The Swedish reflux trial in children: IV. Renal damage.

Purpose: We compared the development of new renal damage in small children with dilating vesicoureteral reflux randomly allocated to antibiotic prophylaxis, endoscopic treatment or surveillance as the control group.

Materials And Methods: Included in the study were 128 girls and 75 boys 1 to younger than 2 years with grade III-IV reflux. Voiding cystourethrography and dimercapto-succinic acid scintigraphy were done before randomization and after 2 years.

The Swedish reflux trial in children: I. Study design and study population characteristics.

Purpose: We compared the rates of febrile urinary tract infection, kidney damage and reflux resolution in children with vesicoureteral reflux treated in 3 ways, including antibiotic prophylaxis, endoscopic therapy and surveillance with antibiotics only for symptomatic urinary tract infection.

Materials And Methods: Children 1 to younger than 2 years with grade III-IV reflux were recruited into this prospective, open, randomized, controlled, multicenter study and followed for 2 years after randomization. The main study end points were recurrent febrile urinary tract infection, renal status on dimercapto-succinic acid scintigraphy and reflux status.

Value of ultrasound in evaluation of infants with first urinary tract infection.

Purpose: We evaluated the role of ultrasound in diagnosing and treating infants with a first urinary tract infection with a focus on important structural abnormalities.

Materials And Methods: In a setting of limited prenatal ultrasound screening this population based, prospective, 3-year study included 161 male and 129 female infants. Ultrasound and dimercapto-succinic acid scintigraphy were performed as initial investigations and voiding cystourethrography was conducted within 2 months.

Predictive factors for resolution of congenital high grade vesicoureteral reflux in infants: results of univariate and multivariate analyses.

Purpose: We studied variables with impact on cessation of congenital high grade vesicoureteral reflux in univariate analyses and provide a multivariate model for prediction of reflux resolution.

Materials And Methods: A total of 80 male and 35 female infants (median age 2.7 months) were included in this prospective observational study.

Change of urodynamic patterns in infants with dilating vesicoureteral reflux: 3-year followup.

Purpose: Reports concerning bladder dysfunction patterns in infants with high grade vesicoureteral reflux during the first year of life vs older children with reflux are contradictory. To describe the development of bladder function characteristics in children with congenital dilating reflux, we evaluated such infants urodynamically and followed them regularly for a 3-year period.

Materials And Methods: A total of 89 males and 25 females with grade III to V dilating reflux were evaluated 3 times using videocystometry at mean ages of 6, 20 and 40 months.

Ultrasonography as predictor of permanent renal damage in infants with urinary tract infection.

Aim: To evaluate the ability of ultrasound (US) in infants (<1 year) with acute urinary tract infection (UTI), to identify those with permanent renal damage (PRD) at scintigraphy 1 year later.

Methods: US, dimercaptosuccinic acid scintigraphy and voiding cystourethrography were performed in 191 infants.

Results: US was abnormal in 46 infants (24%).

Urinary proteins in children with urinary tract infection.

The aim of this study was to test our hypothesis that the urinary excretion of C-reactive protein (CRP), alpha 1-microglobulin (A1M), retinol-binding protein (RBP) and Clara cell protein (CC16) is increased in children with urinary tract infection (UTI) and relates to renal damage as measured by acute dimercaptosuccinic acid (DMSA) scintigraphy. Fifty-two children <2 years of age with UTI were enrolled in the study, 44 of whom were febrile. The control group consisted of 23 patients with non-UTI infection and elevated serum CRP (s-CRP) levels.

Longitudinal development of renal damage and renal function in infants with high grade vesicoureteral reflux.

Purpose: We sought to study renal abnormality and renal function through time in infants with high grade vesicoureteral reflux.

Materials And Methods: This prospective observational study included 115 infants (80 boys and 35 girls) younger than 1 year with grade III to V vesicoureteral reflux. The diagnosis was made after prenatal ultrasound in 26% of the patients and after urinary tract infection in 71%.

Cardiopulmonary data in response to 6 months of training in physically active adult patients with classic cystic fibrosis.

Background: The optimal training mode for cystic fibrosis (CF) patients has not been defined.

Objective: This study aimed to investigate cardiopulmonary function before and after endurance (ET) or resistance training (RT) for 6 months.

Methods: Twenty physically active adult patients (8 females) with classic CF were enrolled for ET or RT for 3 months followed by 3 months of mixed training.

Abnormalities in myocardial perfusion after surgical correction of pulmonary atresia with intact ventricular septum.

We describe the results of myocardial perfusion scintigraphy performed 4 to 15 years after surgery in 12 patients with pulmonary atresia and intact ventricular septum. We used single photon emission computed tomography after injection of technetium Tc-99m tetrofosmin at submaximal exercise test. The patients, 7 girls and 5 boys, with a mean age of 11 years, and a range from 6 to 19 years, had either undergone biventricular repair, in 5 cases, or univentricular palliation in the remaining 7.

Normal dimercaptosuccinic acid scintigraphy makes voiding cystourethrography unnecessary after urinary tract infection.

Objective: To test the hypothesis that infants with dilating vesicoureteral reflux (VUR) have abnormal acute dimercaptosuccinic acid (DMSA) scintigraphy results, as was suggested by an earlier retrospective study.

Study Design: We conducted a prospective study of infants <1 year old with first diagnosed symptomatic urinary tract infection at the Children's Hospital of Göteborg, Sweden. Two hundred ninety consecutive children (161 boys and 129 girls) with complete records were examined.

Guidelines for lung scintigraphy in children.

The purpose of this set of guidelines is to help the nuclear medicine practitioner perform a good quality lung isotope scan. The indications for the test are summarised. The different radiopharmaceuticals used for the ventilation and the perfusion studies, the technique for their administration, the dosimetry, the acquisition of the images, the processing and the display of the images are discussed in detail.