Pediatric Nephrology

, Volume 9, Issue 2, pp 221–226 | Cite as

Update on dimercaptosuccinic acid renal scanning in children with urinary tract infection

  • Noemia P. Goldraich
  • Isidoro H. Goldraich
Practical Pediatric Nephrology


The dimercaptosuccinic acid (DMSA) renal scan is a method for assessing kidney function. Indications for DMSA scanning in children with urinary tract infection (UTI), as well as timing, have changed. Pitfalls in interpreting DMSA scans include: (1) acute pyelonephritis (APN), (2) tubular dysfunction, (3) hypertension, (4) use of captopril in patients with renovascular hypertension and (5) duplex kidneys. Interpretation of DMSA scans in children with UTI vary according to timing and clinical setting. During the course of a febrile UTI a DMSA scan may reveal a normal kidney, APN or a non-functioning, small and/or ectopic kidney. In the absence of UTI (up to 6 months) in children with vesicoureteric reflux a DMSA scan may indicate a normal kidney, renal scarring (reflux nephropathy), occult duplex kidney and allows the progression of scarring and hypertrophy of normal areas of the kidney to be followed anatomically. The DMSA renal scan in now the most reliable test for the diagnosis of APN. The transient abnormalities due to APN can occur in normal or scarred kidneys. Lesions due to reflux nephropathy (defined as a defect in the renal outline or contraction of the whole kidney) are permanent. Intravenous urography reveals renal abnormalities later than the DMSA scan. If abnormalities are seen on a DMSA scan performed during the course of APN it is impossible to predict the outcome: they can progress to permanent scarring or heal completely. An abnormal DMSA scan during a febrile UTI allows the identification of children at risk of developing renal scars. These children should be carefully investigated, maintained on long-term quimioprophylaxis and followed.

Key words

Dimercaptosuccinic acid scan Urinary tract infection Vesicoureteric reflux Acute pyelonephritis Renal scarring 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Goldraich NP, Goldraich IH, Anselmi OE, Ramos OL (1984) Reflux nephropathy: the clinical picture in South Brazilian children. Contrib Nephrol 39: 52–67Google Scholar
  2. 2.
    Rushton HG, Majd M, Chandra R, Yim D (1988) Evaluation of99mtechnetium-dimercapto-succinic acid renal scans in experimental acute pyelonephritis in piglets. J Urol 140: 1169–1174Google Scholar
  3. 3.
    Rushton HG, Majd M, Jantausch B, Wiedermann BL, Belman AB (1992) Renal scarring following reflux and nonreflux pyelonephritis in children: evaluation with99mtechnetium-dimercaptosuccinic acid scintigraphy. J Urol 147: 1327–1332Google Scholar
  4. 4.
    Goldraich NP, Alvarenga AR, Goldraich IH, Ramos OL, Sigulem D (1985) Renal accumulation of99mTc-DMSA in the artificially perfused isolated rat model. J Urol 134: 1282–1286Google Scholar
  5. 5.
    Provoost AP, Van Acker M (1985) Renal handling of technetium-99m DMSA in rats with proximal tubular dysfunction. J Nucl Med 26: 1063–1067Google Scholar
  6. 6.
    Lange MJ de, Piers DA, Kosterink JGW, Luijk WHJ van, Meijer S, Zeeuw D, Hem GK van der (1989) Renal handling of technetium-99m DMSA: evidence for glomerular filtration and peritubular uptake. J Nucl Med 30: 1219–1223Google Scholar
  7. 7.
    Goldraich NP, Yan S, Shah V, Goldraich IH, Gordon I, Dillon MJ, Barratt TM (1987)99mTc-DMSA urinary excretion: a new test to assess tubular function. Tenth International Congress of Nephrology, London. The Alden Press, Oxford, p 64Google Scholar
  8. 8.
    Hovinga TKK, Beukhol JR, Luik WHJ van, Piers DA, Donker AJM (1984) Reversible diminished renal99mTc-DMSA uptake during converting-enzyme inhibition in a patient with renal artery stenosis. Eur J Nucl Med 9: 144–146Google Scholar
  9. 9.
    Peters AM, Jones DH, Evans K, Gordon I (1988) Two routes for99mTc-DMSA uptake into the renal cortical tubular cell. Eur J Nucl Med 14: 555–561Google Scholar
  10. 10.
    Goldraich NP (1991) Reflux nephropaphy: the continuing challenge. Proceedings of the Second CJ Hodson Symposium on Reflux Nephropathy. Christchurch, New Zealand. Design Printing Services, Christchurch, pp 23–31Google Scholar
  11. 11.
    Smellie JM, Normand ICS (1976) Urinary tract infection with and without anatomic malformations. In: Lieberman E (ed) Clinical pediatric nephrology. Lippincott, Philadelphia, pp 194–224Google Scholar
  12. 12.
    Goldraich NP, Ramos OL, Goldraich IH (1989) Urography versus DMSA scan in children with vesicoureteric reflux. Pediatr Nephrol 3: 1–5Google Scholar
  13. 13.
    Majd M, Rushton HG (1992) Renal cortical scintigraphy in the diagnosis of acute pyelonephritis. Semin Nucl Med 22: 98–111Google Scholar
  14. 14.
    Goldraich NP (1991) Reflux nephropathy: the place of the DMSA renal scan. In: Bailey RR (ed). Proceedings of the Second CJ Hodson Symposium on Reflux Nephropathy. Christchurch, New Zealand. Design Printing Services, Christchurch, pp 9–13Google Scholar
  15. 15.
    Melis K, Vandevivere J, Hoskens C, Vervaet A, Sand A, Van Acker KJ (1992) Involvement of the renal parenchyma in acute urinary tract infection: the contribution of99mTc dimercaptosuccinic acid scan. Eur J Pediatr 151: 536–539Google Scholar
  16. 16.
    Wallin L, Bajc M (1993) Typical technetium dimercaptosuccinic acid distribution patterns in acute pyelonephritis. Acta Paeditr 82: 1061–1065Google Scholar
  17. 17.
    Rushton HG (1992) Discussion. J Urol 148: 1735–1738Google Scholar
  18. 18.
    Parkhouse HF, Goldley ML, Cooper J, Risdon RA, Ransley PG (1989) Renal imaging with99Tcm-labelled DMSA in the detection of acute pyelonephritis: an experimental study in the pig. Nucl Med Commun 10: 63–70Google Scholar
  19. 19.
    Wikstad I, Hannerz L, Karlsson A, Eklof AC, Olling S, Aperia A (1990) A99mtechnetium dimercaptosuccinic acid scintigraphy in the diagnosis of acute pyelonephritis in rats. Pediatr Nephrol 4: 331–334Google Scholar
  20. 20.
    Tappin DM, Murphy AV, Mocan H, Shaw R, Beattie TJ, McAllister TA, Mackensie JR (1989) A prospective study of children with first acute symptomaticE. coli urinary tract infection. Acta Paediatr Scand 78: 923–929Google Scholar
  21. 21.
    Verboven M, Ingels M, Delree M, Piepsz A (1990)99mTc-DMSA scintigraphy in acute urinary tract infection in children. Pediatr Radiol 20: 540–542Google Scholar
  22. 22.
    Bjórgvinsson E, Majd M, Eggli KD (1991) Diagnosis of acute pyelonephritis in children: comparison of sonography and99mTc-DMSA scintigraphy. AJR 157: 539–543Google Scholar
  23. 23.
    Jakobsson B, Soderlundh S, Berg U (1992) Diagnostic significance of99mTc-dimercaptosuccinic acid (DMSA) scintigraphy in urinary tract infection. Arch Dis Child 67: 1338–1342Google Scholar
  24. 24.
    Jakobsson B, Nolstedt L, Svensson L, Soderlundh S, Berg U (1992)99mTechnetium-dimercaptosuccinic acid scan in the diagnosis of acute pyelonephritis in children: relation to clinical and radiological findings. Pediatr Nephrol 6: 328–334Google Scholar
  25. 25.
    Kass EJ, Fink-Bennett D, Cacciarelli AA, Balon H, Pavlock S (1992) The sensitivity of renal scintigraphy and sonography in detecting nonobstructive acute pyelonephritis. J Urol 148: 606–608Google Scholar
  26. 26.
    Rushton HG, Majd M (1992) Dimercaptosuccinic acid renal scintigraphy for the evaluation of pyelonephritis and scarring: a review of experimental and clinical studies. J Urol 148: 1726–1732Google Scholar
  27. 27.
    Majd M, Rushton HG, Jantaush B, Wiedermann BL (1992) Relationship among vesicoureteral reflux, p-fimbriatedEscherichia coli, and acute pyelonephritis in children with febrile urinary tract infection. J Pediatr 119: 578–585Google Scholar
  28. 28.
    Smellie JM (1989) The DMSA scan and intravenous urography in the detection of renal scarring. Pediatr Nephrol 3: 6–8Google Scholar
  29. 29.
    Smellie JM, Shaw PJ, Prescod NP, Bantock HM (1988)99mTc dimercaptosuccinic acid (DMSA) scan in patients with established radiological renal scarring. Arch Dis Child 63: 1315–1319Google Scholar
  30. 30.
    Goldraich NP, Goldraich IH (1992) Follow up of conservatively treated children with high and low grade vesicoureteral reflux: a prospective study. J Urol 148: 1688–1692Google Scholar
  31. 31.
    Verber IG, Strudley MR, Meller ST (1988)99mTc dimercaptosuccinic acid (DMSA) scan as first investigation of urinary tract infection. Arch dis Child 63: 1320–1325Google Scholar
  32. 32.
    Hodson CJ (1967) The radiological contribution toward the diagnosis of chronic pyelonephritis. Radiology 88: 857–871Google Scholar
  33. 33.
    Harrison RB, Howards SS, Thomas BR (1976) Medial deviation of the upper pole calyx on the intravenous urogram as an indication of vesicoureteral reflux. Am J Roentgenol 126: 1189–1193Google Scholar
  34. 34.
    Gedroyc WMW, Chaudhuri R, Saxton HM (1988) Normal and near normal caliceal patterns in reflux nephropathy. Clin Radiol 39: 615–619Google Scholar
  35. 35.
    The International Reflux Study in Children (1992) Five-year study of medical or surgical treatment in children with severe reflux: radiological renal findings. Pediatr Nephrol 6: 223–230Google Scholar
  36. 36.
    Olbing H, Claesson I, Ebel K-D, Seppanen U, Smellie JM, Tamminen-Mobius T, Wikstad I, on behalf of the International Reflux Study in Children (1992) Renal scars and parenchymal thinning in children with vesicoureteral reflux: a 5-year report of the International Reflux Study in Children (European branch). J Urol 148: 1653–1656Google Scholar
  37. 37.
    Weiss R, Duckett J, Spitzer A on behalf of the International Reflux Study in Children (1992) Results of a randomized clinical trial of medical versus surgical management of infants and children with grades III and IV primary vesicoureteral reflux (United States). J Urol 148: 1667–1673Google Scholar
  38. 38.
    Smellie JM, Ransley PG, Normand ICS, Prescod N, Edwards D (1985) Development of new renal scars: a collaborative study. BMJ 290: 1957–1960Google Scholar
  39. 39.
    Winberg J (1992) Commentary: progressive renal damage from infection with and without reflux. J Urol 148: 1733–1734Google Scholar

Copyright information

© IPNA 1995

Authors and Affiliations

  • Noemia P. Goldraich
    • 1
  • Isidoro H. Goldraich
    • 1
  1. 1.Paediatric Nephrology Unit, Department of PaediatricsHospital de Clinicas de Porto Alegre and Centro de Nefrologia InfantilPorto AlegreBrazil

Personalised recommendations