Abstract
Imaging of children who had symptoms and signs of pyelonephritis is aimed to diagnosis of renal injury and identification of risk factors for pyelonephritis that might be uncovered during imaging includes vesico- ureteric reflux (VUR). The purpose of this study was to determine the role of static renal scintigraphy in diagnosis of pediatric renal pyelonephritis and the value of single photon emission computed tomography (SPECT) in diagnosis. This study was carried out on 50 patients in Radiology Department at Mansoura Urology and Nephrology center and Radiology department at Tanta university hospitals. High grade vesicoureteric reflux (grade IV & V) was detected in 70% of the cases. 42.8% of the cases had vesicoureteric reflux in both kidneys, 42.8% of the cases had VUR only on the left side and 14.2% of the cases had VUR on the right side. A statistical significance was found between grades of pyelonephritis and grades of vescio-ureteric reflux, so there was a strong association between high grade VUR and renal pyelonephritis. It was found that no significant difference was found as regard to the number of abnormal segments detected by static renal scintigraphy and SPECT imaging. Static renal scintigraphy is considered the gold standard for diagnosis of children with pyelonephritis and detection the risk of renal scarring due to recurrent infection. SPECT offers no statistically significant diagnostic advantage over static images for detection of cortical defects.
Highlights
Urinary tract infections (UTIs) are common in infants and children affecting girls than boys and may result in serious complications, such as renal scarring, hypertension, and renal failure
High grade vesicoureteric reflux vesico-ureteric reflux (VUR) was detected in 35 out of 50 (70%) cases. 15 out of 50 (30%) cases showed no evidence of VUR
A statistical significance was found between grades of pyelonephritis and grades of vesicoureteric reflux with MCp (
Summary
Urinary tract infections (UTIs) are common in infants and children affecting girls than boys and may result in serious complications, such as renal scarring, hypertension, and renal failure. Urinary tract infections are classified into lower tract and upper tract. UTI caused by ascending route (most common) and through a hematogenous route. UTI can be caused by multiple organisms and gram-negative bacteria are most frequently identified. The Escherichia coli is the most common one [1, 2]. Renal pyelonephritis is diagnosed clinically in patients with a sudden onset of fever, flank pain, costo-vertebral angle tenderness, and microscopic evidence of urinary infection [2]. The role of imaging in UTI is to detect children with a high risk for developing renal scarring, who need routinely screening and follow up [3]
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