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Acute phase 99mTc-dimercaptosuccinic acid scan in infants with first episode of febrile urinary tract infection

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Abstract

Background

99mTc-dimercaptosuccinic acid (DMSA) scan is the golden standard for the diagnosis of acute pyelonephritis and renal scaring. We investigated the use of acute phase DMSA scan in infants presented promptly to the hospital because of the first episode of their febrile urinary tract infection (UTI).

Methods

Ninety-eight infants with microbiologically confirmed first episode of febrile UTI were studied. DMSA scans were carried out within 7 days in these infants after admission. Infants with an abnormal acute DMSA scan underwent a second DMSA scan 6–12 months later.

Results

Overall, acute DMSA scan was abnormal in 16 (16.3%) of the 98 patients. There were no differences in sex, age, fever over 38.5°C, blood inflammation indices, or evidence of vesicoureteral reflux (VUR) between patients with normal and abnormal acute DMSA scan (P>0.05). However, infants with grade III to V VUR as well as those with delayed treatment presented significantly increased renal involvement by acute DMSA scan (P<0.05). The sensitivity and specificity of abnormal acute DMSA scan to predict grade III to V VUR were 50% and 88% respectively. Its positive and negative likelihood ratios were 4.16 and 0.57, respectively. Of 16 children with abnormal initial DMSA scan results, 14 underwent a second DMSA scan. Follow-up DMSA scans were normal in 12 of the 14 children.

Conclusions

Parenchymal damage found in a minority of infants with febrile UTI presented promptly to the hospital. Acute phase DMSA scan should be carried out only in selected patients. An abnormal acute DMSA scan is a moderate predictor for dilated VUR and its ability to exclude VUR is restricted.

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Authors and Affiliations

  1. 1st Pediatric Department, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece

    Nikoleta Printza, Evagelia Farmaki, Kalliopi Piretzi & Fotios Papachristou

  2. Department of Nuclear Medicine, Hippokration General Hospital, Thessaloniki, Greece

    George Arsos

  3. 3rd Pediatric Department, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece

    Konstantinos Kollios

  4. 1st Pediatric Department, Aristotle University, Hippokration Hospital, 49 Konstantinoupoleos St., GR-546 42, Thessaloniki, Greece

    Nikoleta Printza

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  1. Nikoleta Printza
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  2. Evagelia Farmaki
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Correspondence to Nikoleta Printza.

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Printza, N., Farmaki, E., Piretzi, K. et al. Acute phase 99mTc-dimercaptosuccinic acid scan in infants with first episode of febrile urinary tract infection. World J Pediatr 8, 52–56 (2012). https://doi.org/10.1007/s12519-012-0335-7

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  • DOI: https://doi.org/10.1007/s12519-012-0335-7

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