Tsai et al used a simple algorithm to detect asymptomatic vesicoureteral reflux in neonates using an ultrasonographic screening protocol. The authors are from Taipei in Taiwan.
Initial ultrasonography (US) is performed at > 2 days of age.
|
US Findings |
Action |
|
normal |
no further action |
|
mild pelvic dilatation or mild hydronephrosis |
repeat US in 1 month (see next table) |
|
moderate to severe hydronephrosis |
voiding cystourethrography |
|
dilated ureter |
voiding cystourethrography |
|
Repeat US Findings at 1 Month |
Action |
|
normal (no dilatation) |
no further followup |
|
mild pelvic dilatation or mild hydronephrosis |
repeat US in 3 months (4 months after initial US, see next table) |
|
moderate to severe hydronephrosis |
voiding cystourethrography |
|
dilated ureter |
voiding cystourethrography |
|
Repeat US Findings after 3 Months |
Action |
|
normal (no dilatation) |
no further followup |
|
mild pelvic dilatation |
no further followup |
|
mild hydronephrosis |
voiding cystourethrography |
|
moderate to severe hydronephrosis |
voiding cystourethrography |
|
dilated ureter |
voiding cystourethrography |
If voiding cystourethrography shows reflux, then vesicoureteral reflux is diagnosed.
Performance:
• Sensitivity 62%, specificity 36%, positive predictive value 11%, negative predictive value 88%. The cases missed by screening ultrasonography (only moderately sensitive) were picked up when voiding cystourethrography was performed on infants with urinary tract infections.
• Looking at the 2x2 Table 2 (page 207) used to calculate performance, I am not sure why the negative/negative should not be larger (nearer 2,000), since 2,384 infants were screened.
Specialty: Nephrology, Clinical Laboratory
ICD-10: ,
