DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20180590

Study of DMSA (99mTc-dimercaptosuccinic acid) scan disorders in children 1-12 years with first acute pyelonephritis and its association with vesicoureteral reflux

Majid Vafaie, Javad Zare-noghabi, Hadiseh Bahri

Abstract


Background: Acute pyelonephritis and vesicoureteral reflux are one of the main causes of renal scarring in children, which can lead to serious complications such as hypertension and chronic renal failure. The aim of this study was to evaluate the scan disorders in children aged 1-12 years with acute pyelonephritis and its relation with ureteral bladder reflux.

Methods: This retrospective cross-sectional descriptive study was conducted on all patients who had been diagnosed with febrile UTI for 4 years (2012-2015) in Ardebil's Children's Hospital. Information about 99mTc-DMSA scan and ultrasonography and cystoyurethrography of patients were extracted from the files and then analyzed by statistical methods inSPSS.19.

Results: 148 children (9 boys and 139 girls) with a range of 1 to 12 years old (mean age of 52.34±4.34 months) were included in the study. Of these, 123 patients were subjected to cystoyurethrography after a negative urine culture. A 99mTc-DMSA scan report in the acute phase of the disease was abnormal in 80.4% of the children. VCUG and RNC tests were performed in 123 patients, in 70 (57%) normal cases, and in 53 cases (43%) of urinary reflux. The incidence of reflux with abnormal 99mTc-DMSA scan was 42%. There was no significant correlation between the prevalence of reflux in patients with abnormal 99mTc-DMSA scan in two groups of 1-4 years old and more than 4 years old. No significant difference was found in patients with abnormal scan in responding to treatment and comparing fever after admission in patients with normal 99mTc-DMSA.

Conclusions: The results indicate high prevalence of reflux in patients with acute pyelonephritis. Due to the high sensitivity of the scan to detect pyelonephritis and, Pyelonephritis.


Keywords


Acute pyelonephritis, Children, 99mTc-DMSA scan, Vesicoureteral reflux

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References


Marcdante K, Kliegman RM. Nelson essentials of pediatrics (7th ed). Philadelphia, PA: Elsevier, 2015.

Chand DH, Rhoades T, Poe SA, Kraus S, Strife CF. Incidence and severity of vesicoureteral reflux in children related to age, gender, race and diagnosis. J Urology. 2003;170(4):1548-50.

Kliegman RM, Behrman RE, Jenson HB, Stanton BM. Nelson Textbook of Pediatrics E-Book: Elsevier Health Sciences; 2007.

Ajdinović B, Jauković L, Krstić Z, Dopuđa M. Impact of micturating cystourethrography and DMSA renal scintigraphy on the investigation scheme in children with urinary tract infection. Annals nuclear medicine. 2008;22(8):661.

Lee RS, Diamond DA, Chow JS. Applying the ALARA concept to the evaluation of vesicoureteric reflux. Pediatric radiology. 2006;36(2):185-91.

Benador D, Benador N, Slosman DO, Nusslé D, Mermillod B, Girardin E. Cortical scintigraphy in the evaluation of renal parenchymal changes in children with pyelonephritis. J pediatrics. 1994;124(1):17-20.

Smellie J, Rigden S, Prescod N. Urinary tract infection: a comparison of four methods of investigation. Archives of disease in childhood. 1995;72(3):247-50.

Narchi H, Donovan R. Renal power Doppler ultrasound does not predict renal scarring after urinary tract infection. Scott Med J. 2008;53(4):7-10.

Basiratnia M, Noohi AH, Lotfi M, Alavi MS. Power Doppler sonographic evaluation of acute childhood pyelonephritis. Pedia Nephrol. 2006;21(12):1854-7.

Craig JC, Irwig LM, Knight JF, Roy LP. Does treatment of vesicoureteric reflux in childhood prevent end-stage renal disease attributable to reflux nephropathy? Pediatrics. 2000;105(6):1236-41.

Little P, McPherson D, De Wardener H. The appearance of the intravenous pyelogram during and after acute pyelonephritis. Lancet. 1965;285(7397):1186-8.

Schneider M, Becker J, Staiano S, Campos E. Sonographic-radiographic correlations of renal and perirenal infections. Ame J Roentgenol. 1976;127(6):1007-14.

Hansson S, Martinel J. The natural history of bacteriuria in childhood. Infec Dis Clin North Am. 1997;11:499-512.

McRae SN, Dairiki-shortliffe L (2000). Bacterial infections of the genitourinary tract. In: McAninch JW,Tanago E (eds) Smith´s general urology, 15th ed. McGraw-Hill, New York, PP:237-264.

Abedi SM, Mohammadjafari H, Hosseinimehr SJ, Mardanshahi A, Shahhosseini R. Imaging of renal cortex in nuclear medicine. Clinical Excellence. 2014;2(1):50-69.

Austin JC, Hardy RD, Grose C. DMSA renal scans and the top-down approach to urinary tract infection. Pediatric infectious disease J. 2008;27(5):476-7.

Rushton H, Majd M, Jantausch B, Wiedermann B, Belman A. Renal scarring following reflux and nonreflux pyelonephitis evaluation with 99-Tc DMSA scitigraphy. J Urol. 1992;145:1327-32.

Jakobsson B, Nolstedt L, Svensson L, Söderlundh S, Berg U. 99m Technetium-dimercaptosuccinic acid scan in the diagnosis of acute pyelonephritis in children: relation to clinical and radiological findings. Pediatric Nephrol. 1992;6(4):328-34.

Ajdinović B, Jauković L, Krstić Z, Dopuda M. Technetium-99m-dimercaptosuccinic acid renal scintigraphy in children with urinary tract infections. Hellenic J Nuclear Med. 2005;9(1):27-30.

Tseng MH, Lin WJ, Lo WT, Wang SR, Chu ML, Wang CC. Does a normal DMSA obviate the performance of voiding cystourethrography in evaluation of young children after their first urinary tract infection? J pediatrics. 2007;150(1):96-9.

Zhang X, Xu H, Zhou L, Cao Q, Shen Q, Sun L, et al. Accuracy of early DMSA scan for VUR in young children with febrile UTI. Pediatr. 2014;133(1):e30-e8.

Rushton HG, Majd M. Dimercaptosuccinic acid renal scintigraphy for the evaluation of pyelonephritis and scarring: a review of experimental and clinical studies. J Urology. 1992;148(5):1726-32.

Jacobson SH, Eklöf O, Eriksson CG, Lins L-E, Tidgren B, Winberg J. Development of hypertension and uraemia after pyelonephritis in childhood: 27 year follow up. BMJ. 1989;299(6701):703-6.

Rickwood A, Carty H, McKendrick T, Williams M, Jackson M, Pilling D, et al. Current imaging of childhood urinary infections: prospective survey. BMJ. 1992;304(6828):663-5.

Risdon RA, Godley ML, Parkhouse HF, Gordon I, Ransley PG. Renal pathology and the 99mTc-DMSA image during the evolution of the early pyelonephritic scar: an experimental study. J urology. 1994;151(3):767-73.

Ataei N, Madani A, Habibi R, Khorasani M. Evaluation of acute pyelonephritis with DMSA scans in children presenting after the age of 5 years. Pediatric nephrology. 2005;20(10):1439-44.

Mohkam M, Maham S, Rahmani A, Naghi I, Otokesh B, Raiati H, et al. Technetium Tc 99m dimercaptosuccinic acid renal scintigraphy in children with acute pyelonephritis: correlation with other imaging tests. Iranian J kidney diseases. 2010;4(4):297.

Hashemian H, Tabatabaee P, Siadati A, Ataee N. Prognostic value of the acute DMSA scan in hospitalized children with urinary tract infection. Tehran University Med Sci. 2008;66(9).

Hoberman A, Charron M, Hickey RW, Baskin M, Kearney DH, Wald ER. Imaging studies after a first febrile urinary tract infection in young children. New Eng J Med. 2003;348(3):195-202.

Lin KY, Chiu NT, Chen MJ, Lai CH, Huang JJ, Wang YT, et al. Acute pyelonephritis and sequelae of renal scar in pediatric first febrile urinary tract infection. Pediatric Nephrology. 2003;18(4):362-5.

Ell PJ, Gambhir S. Nuclear medicine in clinical diagnosis and treatment. American J Neuroradiol. 2006;27(2):464.

Ditchfield MR, De Campo J, Cook DJ, Nolan TM, Powell HR, Sloane R, et al. Vesicoureteral reflux: an accurate predictor of acute pyelonephritis in childhood urinary tract infection? Radiology. 1994;190(2):413-5.

Majd M, Rushton HG, Jantausch B, Wiedermann BL. Relationship among vesicoureteral reflux, P-fimbriated Escherichia coli, and acute pyelonephritis in children with febrile urinary tract infection. J pediatrics. 1991;119(4):578-85.

Ataei N, Safaian B, Madani A, Esfahani S, Ataei F. Renal parenchymal changes in children with acute pyelonephritis using DMSA scan and the relationship with certain biologic factors. Tehran University Med J. 2009;67(2):125-31.

Stokland E, Hellström M, Jacobsson B, Jodal U, Sixt R. Evaluation of DMSA scintigraphy and urography in assessing both acute and permanent renal damage in children. Acta radiologica. 1998;39(4):447-52.

Biggi A, Dardanelli L, Pomero G, Cussino P, Noello C, Sernia O, et al. Acute renal cortical scintigraphy in children with a first urinary tract infection. Pediatric nephrology. 2001;16(9):733-8.

Camacho V, Estorch M, Fraga G, Mena E, Fuertes J, Hernandez M, et al. DMSA study performed during febrile urinary tract infection: a predictor of patient outcome? Euro J Nuclear Med Mole Imag. 2004;31(6):862-6.

Wald ER. Vesicoureteral reflux: the role of antibiotic prophylaxis. Pediatrics. 2006;117(3):919-22.

Zaki M, Badawi M, Al Mutari G, Ramadan D, Rahman MA. Acute pyelonephritis and renal scarring in Kuwaiti children: a follow-up study using 99mTc DMSA renal scintigraphy. Pediatric Nephrology. 2005;20(8):1116-9.

Sheu J-N, Wu K-H, Chen S-M, Tsai J-D, Chao Y-H, Lue K-H. Acute 99mTc DMSA scan predicts dilating vesicoureteral reflux in young children with a first febrile urinary tract infection: a population-based cohort study. Clinical nuclear medicine. 2013;38(3):163-8.