Abstract
Introduction: Acute pyelonephritis is a common disease in children leading to permanent renal function impairment due to renal scarring with the risk of later hypertension. Objectives: The aim of this study was to assess the role of initial 99mTc dimercaptosuccinic acid (DMSA) scintigraphy for detecting the early renal parenchymal damage in children with the first episode of acute pyelonephritis (APN). Patients and Methods: This study was conducted among 161 hospitalized children with the first clinically episode of APN from January 2008 to April 2013 in pediatric clinical research of development center in Qom, Iran. DMSA renal scintigraphy, ultrasonography (US), erythrocyte sedimentation rate (ESR), urine analysis and culture were performed in all patients. DMSA renal scan and voiding cystourethrogram(VCUG) was done within 15 days and one month after the diagnosis of APN using the standard protocol, respectively. Results: Children with the first episode of acute pyelonephritis aged 1 month to 12 years were enrolled in this study. There were no statistically significant correlations between initial decreased uptake detected by DMSA renal scan with age, gender, body temperature, CRP levels or ESR. The positive and negative predictive values (PPV, NPV) of diminished uptake on DMSA renal scans for detecting the presence of VUR on VCUG were (43.2%) and (93.3%), respectively. Conclusion: Children with a normal DMSA renal scan during their the first episode of UTI rarely have VUR. Avoidance of VCUG in children with negative DMSA renal scans could significantly eliminate the use of this potentially traumatic test.
Highlights
Acute pyelonephritis is a common disease in children leading to permanent renal function impairment due to renal scarring with the risk of later hypertension
The sensitivity and specificity dimercaptosuccinic acid (DMSA) scan for diagnosing of urinary tract infection (UTI) was 86% and 91% respectively, but it cannot differentiate between the injury by UTI and congenital kidney damage
While we had excluded the patients with underline kidney disease and the patients with history of previous UTI, we considered all cases of abnormal DMSA as acute pyelonephritis (APN)
Summary
Acute pyelonephritis is a common disease in children leading to permanent renal function impairment due to renal scarring with the risk of later hypertension. Objectives: The aim of this study was to assess the role of initial 99mTc dimercaptosuccinic acid (DMSA) scintigraphy for detecting the early renal parenchymal damage in children with the first episode of acute pyelonephritis (APN). DMSA renal scan and voiding cystourethrogram(VCUG) was done within 15 days and one month after the diagnosis of APN using the standard protocol, respectively. There were no statistically significant correlations between initial decreased uptake detected by DMSA renal scan with age, gender, body temperature, CRP levels or ESR. The positive and negative predictive values (PPV, NPV) of diminished uptake on DMSA renal scans for detecting the presence of VUR on VCUG were (43.2%) and (93.3%), respectively. There are several risk factors for renal scar in children after UTI including age, gender, recurrent infection, degree of fever, treatment delay and presence of vesicoureteral reflux (VUR). The effect of inflammatory mediators on scar formation has been studied previously [2]
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