Abstract
BackgroundThe association between renal parenchyma changes on dimercaptosuccinic acid (DMSA) scans and demographic, clinical, and laboratory markers was assessed in pediatric patients with acute pyelonephritis.MethodsA retrospective study of 67 Iranian babies and children aged 1-month to 12-year with APN was conducted between 2012 and 2018. The presence of renal parenchymal involvement (RPI) during APN was determined using technetium-99m DMSA during the first 2 weeks of hospitalization. The association of DMSA results with demographic data, clinical features (hospitalization stay, fever temperature and duration), and laboratory parameters such as pathogen type, and hematological factors (ESR, CRP, BUN, Cr, Hb, and WBC) was evaluated.Results92.5% of children with an average age of 43.76 ± 5.2 months were girls. Twenty-four children (35.8%) did not have renal parenchymal injury (RPI), while 26 (38.8%) and 17 (25.4%) patients showed RPI in one and both kidneys, respectively. There was no significant association between RPI and mean ESR, CRP, BUN, and WBC. However, there were significant associations between RPI and higher mean levels of Cr, Hb, and BMI.ConclusionsLow BMI and Hb levels and increased Cr levels might be indicative of the presence of RPI in children with APN.
Highlights
The association between renal parenchyma changes on dimercaptosuccinic acid (DMSA) scans and demographic, clinical, and laboratory markers was assessed in pediatric patients with acute pyelonephritis
43 (64.2%) had renal parenchymal involvement, renal parenchymal injury (RPI), on DMSA scan while 24 (35.8%) did not. Among those with RPI (n = 43), it was unilateral in 26 children (60.5%) and bilateral in 17 (39.5)
The only significant differences were in body mass index (BMI), and serum creatinine and hemoglobin levels (Tables 1 and 2)
Summary
The association between renal parenchyma changes on dimercaptosuccinic acid (DMSA) scans and demographic, clinical, and laboratory markers was assessed in pediatric patients with acute pyelonephritis. Urinary tract infection (UTI) is one of the most common childhood bacterial diseases worldwide [1,2,3]. It is more prevalent in girls than boys [4]. Upper UTI could cause renal parenchymal injury (RPI) and subsequent progression to formation of renal parenchymal scars. UTI can involve the upper tract especially kidneys (acute pyelonephritis (APN)) and/or the lower urinary tract including urethra (urethritis) or the bladder (cystitis) [2,3,4]. Finding the proper methodologies for timely diagnosis and treatment is essential because any delay significantly increases the risk of complications such as hypertension, preeclampsia, growth retardation, and progressive kidney scarring and failure later in life [8,9,10]
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