The authors propose that the ultrasound finding of nephromegaly at febrile UTI can be used to determine children at risk for renal scarring based on their findings that nephromegaly is associated with clinical signs of inflammation, such as duration of fever before and after initiation of treatment, WBC count and C-reactive protein level. They performed a multivariate analysis that demonstrated in the presence of VUR nephromegaly conferred a 70.036 OR for the risk of renal scarring. Proponents of the top-down approach might be swayed to abandon DMSA renal scans in favor of ultrasound but for the fact that nephromegaly may not be present in as many as 30% of children with significant renal scarring per their own data.
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