Abstract
99mTc-DMSA scan is the best investigation to assess renal scarring after urinary tract infection (UTI) in children. The aim of this study was to describe the findings of DMSA scans done six months after the first UTI. A descriptive cross-sectional study was done among 110 boys and 80 girls selected by systematic sampling. Urine culture was positive in 164 (86.3%) children. There was no statistically significant association between the DMSA scan result and gender, family history of UTI (p=1.00), family history of vesico-ureteric reflux (p=1.00), febrile UTI (p=0.134) and positive urine culture (p=1.00).In 93.7% of children DMSA scan was negative. Hence routinely recommending DMSA scans following UTI must be reconsidered.
Highlights
Urinary tract infection (UTI) is the most common bacterial infection among infants and young children [1]
UTIs may be limited to the lower urinary tract or involve the renal parenchyma, which may lead to renal cortical scarring [2]
99mTc dimercaptosuccinic acid (99mTc-DMSA) scan is the best investigation to assess renal scarring after UTI in children. 99mTc-DMSA binds to the proximal convoluted tubules of the renal tissues, and most of it gets fixed to the renal parenchyma, resulting in an unchanging image over many hours
Summary
Urinary tract infection (UTI) is the most common bacterial infection among infants and young children [1]. UTIs may be limited to the lower urinary tract or involve the renal parenchyma, which may lead to renal cortical scarring [2]. 99mTc dimercaptosuccinic acid (99mTc-DMSA) scan is the best investigation to assess renal scarring after UTI in children. A previous study found that acute phase DMSA scans were abnormal in 16.3%, but follow-up DMSA scans done 6-12 months later revealed no abnormality in 12 out of the 14 patients [5]. 309 children with UTI were investigated by DMSA scans during the acute period and repeated after 6 months. The repeat scans showed renal scars in 9.5% of the children [6]. Another study revealed similar results, showing renal scars in 9.8% of children in the follow-up DMSA scan [7]
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