Delayed Therapeutic Response Time Predicts Renal Damage
in the First Episode of Febrile Urinary Tract Infection
Suroj Supavekin MD*, Saowalak Hunnangkul PhD**, Nanthiya Pravitsitthikul MD*, Siwinee Kutanavanishapong MD*,
Sunanta Chiewvit MD***, Nuntawan Piyaphanee MD*, Anirut Pattaragarn MD*, Achra Sumboonnanonda MD*
Affiliation :
* Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
** Office for Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
*** Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : To evaluate the relationship of therapeutic delay time (TDT) and therapeutic response time (TRT) with renal
damage in the first episode of febrile urinary tract infection (UTI).
Material and Method: A prospective study was conducted in 67 children with the first episode of UTI at the Department of
Pediatrics, Faculty of Medicine Siriraj Hospital between 2008 and 2010. To assess for renal damage, dimercaptosuccinic
acid (DMSA) renal scintigraphy was performed at one and six months after the acute episode.
Results : Abnormal DMSA renal scintigraphy was detected in 20 (29.9%) patients. There was no difference in TDT but TRT
was different between the patients with normal and abnormal DMSA renal scintigraphy at p-value 0.001. The area under
receiver operating characteristic (ROC) curve for TRT was 0.76 (95% confidence interval (CI) 0.64-0.86) at p-value 0.001.
The optimal cut-off value for TRT was 22 hours with sensitivity 80.0% (56.3-94.1) and specificity 63.6% (47.8-77.6). In
50 patients with no vesicoureteral reflux (VUR), there was difference in TRT at p-value 0.002. The area under ROC curve
for TRT was 0.82 (95% CI 0.69-0.96) at p-value 0.004. The optimal cut-off value for TRT was 25 hours with sensitivity
88.9% (95% CI 51.7-98.2) and specificity 68.4% (95% CI 51.3- 82.5).
Conclusion : TRT at or more than 22 hours predicts renal damage after first episode of UTI. In patients with no VUR, TRT
at or more than 25 hours predicts renal damage. DMSA renal scintigraphy in the first episode of UTI should be considered
in these patients.
Keywords : DMSA renal scintigraphy, Renal damage, Urinary tract infection
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