Abstract
Objective
The aim of this study was to investigate the influence of vesicoureteral reflux (VUR) on dimercaptosuccinic acid (DMSA) scintigraphic patterns in children with first symptomatic urinary tract infection (UTI).
Methods
A total of 45 children with the diagnosis of first symptomatic UTI (28 girls, 17 boys, mean age 18 months, range 1 month-11 years) were reviewed. All DMSA scans were obtained within 2 months of bacteriologically proven UTI (median 21 days, mean 26 ± 21, 14). After the exclusion of the patients with bilateral cortical lesions, 82 renal units were analyzed. The scintigraphic patterns included regional and global description of renal cortical abnormality (normal or decreased differential renal function, regional renal function (RRF), and the number and severity of cortical lesions).
Results
Vesicoureteral reflux was detected in 26 (32%) renal units (15 with grade 1–2, 11 with grade 3–4). Renal cortical abnormality was observed in 10 renal units without VUR (10/56, 17%) and 13 renal units with VUR (13/26: 50%). Of the 15 renal units, 5 with grade 1–2 VUR (5/15) and 8 of the 11 renal units with grade 3–4 VUR (8/11) had renal cortical involvement. The most common scintigraphic pattern in the patients without VUR was the preserved RRF (≥45%) and two or fewer photon-deficient areas. On the other hand, a decreased RRF (<45) associated with cortical lesions was the most frequent finding in patients with refluxing kidneys (8/26, 30%), especially in those with grade 3–4 disease.
Conclusions
This investigation showed that the presence of VUR affects DMSA patterns in children with first symptomatic UTI.
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References
Piepsz A, Ham HR. Pediatric applications of renal nuclear medicine. Semin Nucl Med 2006;36:16–35.
Polito C, Rambaldi PF, Signoriello G, Mansi L, Manna AL. Permanent renal parenchymal defects after febrile UTI are closely associated with vesicoureteric reflux. Pediatr Nephrol 2006;21:521–526.
Rosenberg AR, Rossleigh MA, Brydon MP, Bass SJ, Leighton DM. Evaluation of acute urinary tract infection in children by dimercaptosuccinic acid scintigraphy: a prospective study. J Urol 1992;148:1746–1749.
Sverker H, Damey M, Sigström O, Sixt R, Stokland E, Wennerström M, et al. Dimercapto-succinic acid scintigraphy instead of voiding cystourethrography for infants with urinary tract infection. J Urol 2004;172:1071–1074.
Moorthy I, Easty M, McHugh K, Ridout D, Biassoni L, Gordon I. The presence of vesicoureteric reflux does not identify a population at risk for renal scarring following a first urinary tract infection. Arch Dis Child 2005;90:733–736.
Gordon I, Barcovics M, Pindoria S, Cole TJ, Woolf AS. Primary vesicoureteric reflux as a predictor of renal damage in children hospitalized with urinary tract infection: a systematic review and meta-analysis. J Am Soc Nephrol 2003;14: 739–744.
Rossleigh MA. Renal infection and vesico-ureteric reflux. Semin Nucl Med 2007;37:261–268.
Goldman M, Bistritzer T, Horne T, Zoareft I, Aladjem M. The etiology of renal scars in infants with pyelonephritis and vesicoureteral reflux. Pediatr Nephrol 2000;14:385–388.
Levtchenko E. Role of Tc-99m DMSA scintigraphy in the diagnosis of culture negative pyelonephritis. Peditr Nephrol 2001;16:503–506.
Hoberman A, Charron M, Hickey RW, Baskin M, Kearney DH, Wald ER. Imaging studies after a first febrile urinary tract infection in young children. N Engl J Med 2003;16: 195–202.
Benador D, Benador N, Slosman DO, Nussle D, Mermillod B. Cortical scintigraphy in the evaluation of renal parenchymal changes in children with pyelonephritis. J Pediatr 1994;124:17–20.
Camacho V, Estorch M, Fraga G, Mena E, Fuertes J, Hernandez MA. DMSA study performed during febrile urinary tract infection: a predictor of outcome? Eur J Nucl Med Mol Imaging 2004;31:862–866.
Guidelines for the management of acute urinary tract infection in childhood. J R Coll Physicians Lond 1991;25: 36–42.
Imaging in urinary tract infection. London: British Paediatric Association; 1996.
American Academy of Pediatrics Committee on Quality Improvement Subcommittee on Urinary Tract Infection. Practice parameter: the diagnosis of, treatment, and evaluation of initial urinary tract infection in febrile infants and young children. Pediatrics 1999;103:843–852.
European Association of Nuclear Medicine Guidelines on Tc-99m DMSA Scintigraphy in Children; 13 October 2000.
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Aktaş, G.E., Inanır, S. & Turoğlu, H.T. Renal cortical involvement in children with first UTI: does it differ in the presence of primary VUR?. Ann Nucl Med 22, 877–881 (2008). https://doi.org/10.1007/s12149-008-0202-8
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DOI: https://doi.org/10.1007/s12149-008-0202-8