Cystographie isotopique indirecte couplée à la scintigraphie rénale corticale et détection des reflux vésicorénaux chez les nourrissons et les enfants atteints de pyélonéphrite

Abstract

Vesico-uretero-renal reflux (VRR) and urinary tract infection are closely linked. Without any treatment, reflux nephropathy, hypertension and renal dysfunction are very often encountered. That is why a precocious and reliable diagnosis of RVR should be made. Our retrospective study included 33 infants and children suffering from acute pyelonephritis (APN). They were explored by both 99mTc-MAG3 indirect isotopic cystography (IIC), 99mTc-DMSA cortical renal scintigraphy performed on the same day, and radiological retrograde cystography (RRC). A VRR was expected on the same side than the pyelonephritic kidney. Results from IIC versus RRC and versus renal cortical acute pyelonephritis lesions, which were proved by the “gold standard” DMSA scan, were obtained. IIC detected a same-sided VRR in 52% and CRR in 33% of our patients. Some of them had bilateral lesions. IIC detected an homolateral VRR in 59% instead of 38% with RRC (P<0.05). IIC is a physiological noninvasive examination with a convenient sensitivity and dosimetry to search a VRR. Moreover, it gives in the same time interesting functional information on the kidneys and the urinary tract. Each of these characteristics can be favorably compared with RRC.