Abstract
Introduction: Pyelonephritis-induced renal scarring in children is a major predisposing factor for proteinuria, hypertension, and ultimate renal failure. The aim of this study was to investigate and compare the efficacy of Tc99m dimercaptosuccinic acid (Tc-DMSA) renal scintigraphy and renal ultrasonography (USG) in detecting renal scars in children with primary vesicoureteral reflux (VUR). Materials and methods: Tc-DMSA scan and USG studies were done in 62 children who were admitted to our clinic between 1997 and 2003 because of documented urinary tract infection (UTI) and diagnosed with primary VUR. Renal scarring detection rates of Tc-DMSA scan and USG were compared according to reflux grades. Results: In the whole group, renal scars were detected by Tc-DMSA scan and USG in 55% and 38% of refluxing units, respectively. Detection rates of Tc-DMSA and USG according to reflux grades were as follows: 47% and 29 % in low-grade VUR (grades 1 and 2), 46 % and 25% in mid-grade VUR (grade 3), 76% and 65% in high-grade VUR (grades 4 and 5), respectively. Conclusion: USG was found to be an inappropriate study in the detection of renal parenchymal scars, irrespective of the reflux grade. In this study, Tc-DMSA scan detected scars in 35% of kidneys reported to be normal on USG.
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References
JM Smellie IC Normand (1975) ArticleTitleBacteriuria, reflux and renal scarring Arch Dis Child 50 581–585 Occurrence Handle1:STN:280:CSmD1cnnsVY%3D Occurrence Handle1200674
RR Bailey (1981) ArticleTitleEnd-Stage reflux nephropathy Nephron 27 302–306 Occurrence Handle1:STN:280:Bi6B2s%2FovVM%3D Occurrence Handle7266718
W Mannhardt O Schofer H Schilte-Wassermann (1986) ArticleTitlePathogenic factors in recurrent urinary tract infections and renal scar formation in children Eur J Pediat 145 330–336 Occurrence Handle10.1007/BF00439233 Occurrence Handle1:STN:280:BiiD1c%2FktlE%3D
HO Senekjian WN Suki (1982) ArticleTitleVesicoureteral reflux and reflux nephropathy Am J Nephrol 2 245–250 Occurrence Handle1:STN:280:BiuD2cblsFM%3D Occurrence Handle6764861
KL. Tanja (2002) ArticleTitleSensitivity of ultrasonography in detecting renal parenchymal defects in children Pediatr Nephrol 17 1059–1062
RR Bailey (1982) ArticleTitleThe relationship of vesico-ureteric reflux to urinary tract infection and chronic pyelonephritis-reflux nephropathy Clin Nephrol 2 245–50
A Hoberman M Charron RW Hickey et al. (2003) ArticleTitleImaging studies after a first febrile urinary tract infection in young children The New England TNEJM 348 195–202
A Shanon W Feldman P McDonald et al. (1992) ArticleTitleEvaluation of renal scars by technetium-labeled dimercaptosuccinic acid scan, intravenous urography and ultrasonography: a comparative study J Pediatr 120 399–403 Occurrence Handle1:STN:280:By2C28npsVM%3D Occurrence Handle1311376
J Smellie SPA Rigden NP Precsod (1995) ArticleTitleUrinary tract infection: a comparison of four methods of investigation Arch Dis Child 72 247–250 Occurrence Handle1:STN:280:ByqB28%2FhsF0%3D Occurrence Handle7741578
M Monsour AF Azmy JR MacKenzie (1987) ArticleTitleRenal scarring secondary to vesicoureteral reflux. Critical assessment and new grading Br J Urol 60 320–324 Occurrence Handle1:STN:280:BieD2sfotFE%3D Occurrence Handle3319011
MV Merrick A Notghi N Chalmers et al. (1995) ArticleTitleLong term follow up to determine the prognostic value of imaging after urinary tract infections. Part 2: Scarring Arch Dis Child 72 393–396 Occurrence Handle1:STN:280:ByqA2cvitVw%3D Occurrence Handle7618903
V Bhatnagar DK Mitra S Agarwala et al. (2003) ArticleTitleThe role of DMSA scans in evaluation of the correlation between urinary tract infection, vesicoureteric reflux, and renal scarring Pediatr Surg Int 18 128–134
HG Rushton M Majd B Jantausch et al. (1992) ArticleTitleRenal scarring following reflux and nonreflux pyelonephritis in children: evaluation with 99m technetium-dimercaptosuccinic acid scintigrapy J Urol 147 1327–1332 Occurrence Handle1:STN:280:By2B3srpslY%3D Occurrence Handle1314912
HG Rushton M Majd (1992) ArticleTitleDimercaptosuccinic acid renal scintigraphy for the evaluation of pyelonephritis and scarring: a review of experimental and clinical studies J Urol 148 1726–1732 Occurrence Handle1:STN:280:ByyD2MbotVM%3D Occurrence Handle1331545
JM Smellie PÖ Shaw NP Prescod et al. (1988) ArticleTitle99m Tc dimercaptosuccinic acid (DMSA) scan in patients with established radiological renal scarring Arch Dis Child 63 1315–1319 Occurrence Handle1:STN:280:BiaD2srosVQ%3D Occurrence Handle2849381
JJ Conway (1994) ArticleTitleEvolving role of nuclear medicine for the diagnosis and management of urinary tract infection JPediatr 124 87–90 Occurrence Handle1:STN:280:ByuC3M7gt1Y%3D
A Piepsz MD Blaufox I Gordon et al. (1999) ArticleTitleConsensus on renal cortical scintigraphy in children with urinary tract infection. Scientific committee of radionuclides in nephro-urology Semin Nucl Med 29 160–174 Occurrence Handle1:STN:280:DyaK1M3ltlOntg%3D%3D Occurrence Handle10321827
CJ Hodsaon TMJ Maling PJ McManamon et al. (1975) ArticleTitleThe pathogenesis of reflux nephropathy (chronic atrophic pyelonephritis) Br J Radiol (suppl) 13 1–26
S Bykov L Chervinsky V Smolkin et al. (2003) ArticleTitlePower Doppler sonography versus Tc–99m DMSA scintigraphy for diagnosing acute pyelonephritis in children are these two methods comparable CNM 28 198–203
SE Clarke JM Smellie N Prescod et al. (1996) ArticleTitleTc-99m DMSA studies in pediatric urinary tract infection J Necl Med 37 823 Occurrence Handle1:STN:280:BymB387hvFU%3D
D Benador N Benador DO Solsman et al. (1994) ArticleTitleCortical scintigraphy in the evaluation of renal parenchymal changes in children with pyelonephritis J Pediatr. 124 17–20 Occurrence Handle1:STN:280:ByuC3M7gtFY%3D Occurrence Handle8283371
A Hitzel A Liard P Vera et al. (2002) ArticleTitleColor and power doppler versus dmsa scintigraphy in acute pyelonephritis and in prediction of renal Scarring JNM 43 27–32 Occurrence Handle11801699
F Şimşek Y İlker L Türkeri et al. (1991) ArticleTitleTeflon injection in the treatment of vesicoureteral reflux: a promising alternative for surgery İnt J Urol and Neph 23 27–30
DJ Roebuck RG Howard C Metreweli (1999) ArticleTitleHow sensitive is ultrasound in the detection of renal scars? BR J Radiol 72 345–348 Occurrence Handle1:STN:280:DyaK1MvgtlOnsA%3D%3D Occurrence Handle10474494
AJ Arnold SM Brownless HM Carty et al. (1990) ArticleTitleDetection of renal scarring by DMSA scanning- an experimental study J Pediatr Surg 25 391–393 Occurrence Handle10.1016/0022-3468(90)90377-L Occurrence Handle1:STN:280:By%2BB3s%2Fgs1E%3D Occurrence Handle2158539
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Temiz, Y., Tarcan, T., Önol, F.F. et al. The Efficacy of Tc99m Dimercaptosuccinic Acid (Tc-DMSA) Scintigraphy and Ultrasonography in Detecting Renal Scars in Children with Primary Vesicoureteral Reflux (VUR). Int Urol Nephrol 38, 149–152 (2006). https://doi.org/10.1007/s11255-005-3829-6
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DOI: https://doi.org/10.1007/s11255-005-3829-6