Pediatric Nephrology

, Volume 16, Issue 9, pp 733–738

Acute renal cortical scintigraphy in children with a first urinary tract infection

  • A. Biggi
  • Lorenzo Dardanelli
  • Giulia Pomero
  • Paolo Cussino
  • Chiara Noello
  • Ottavio Sernia
  • Adriano Spada
  • Gianfranco Camuzzini
Original Article

Abstract.

This prospective study, performed in 101 children with a first symptomatic urinary tract infection (UTI), evaluates the diagnostic value of clinical, biological, and ultrasound parameters in detecting children with acute renal infection documented by dimercaptosuccinic acid (DMSA) scintigraphy. In children with a positive DMSA scan, mean C-reactive protein (CRP) was higher than in children with a normal DMSA scan (114±64 vs. 67±38 mg/dl, mean±SD, P=0.0002). The sensitivity and specificity of CRP was 64% and 68%, respectively. In children with severe kidney involvement, mean CRP and white blood count (WBC) were higher than in children with mild/moderate disease (151±83 vs. 92±55 mg/dl for CRP, P=0.0149; 20,100±6,854 vs. 15,023±6,145 WBC/ mm3 for WBC, P=0.0131). The sensitivity and specificity was 85% and 20% for CRP, and 77% and 18% for WBC, respectively. One or more areas of abnormal cortical echogenicity were documented in 3% of kidneys with positive DMSA scans. Dilatation of the collecting system was observed in 24% of kidneys. The sensitivity and specificity of ultrasonography was 27% and 89%, respectively. In conclusion, clinical, biological, and ultrasound parameters do not accurately distinguish cystitis from pyelonephritis in children with UTI and do not identify children with severe renal damage. Accordingly, we recommend that DMSA scan should be added to the initial work-up of children with UTI.

Keywords Acute pyelonephritis Dimercaptosuccinic acid renal scintigraphy Urinary tract infection C-reactive protein 

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Copyright information

© IPNA - International Pediatric Nephrology Association New York, USA 2001

Authors and Affiliations

  • A. Biggi
    • 1
  • Lorenzo Dardanelli
    • 2
  • Giulia Pomero
    • 2
  • Paolo Cussino
    • 3
  • Chiara Noello
    • 3
  • Ottavio Sernia
    • 3
  • Adriano Spada
    • 2
  • Gianfranco Camuzzini
    • 1
  1. 1.Nuclear Medicine Service, S. Croce General Hospital, via Coppino 25, 12100 Cuneo, Italy. alberto.biggi@multiwire.netIT
  2. 2.Pediatric Division, S. Croce General Hospital, Cuneo, ItalyIT
  3. 3.Pediatric Division, SS. Annunziata General Hospital, Savigliano, ItalyIT

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