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Follow-up of acute pyelonephritis in children by Tc-99m DMSA scintigraphy: quantitative and qualitative assessment
1Department of Clinical Physiology, Lund University Hospital, S-221 85 Lund, Sweden. lena.wallin@klinfys.lu.se
Insights
Tc-99m DMSA scintigraphy can identify children at risk for progressive kidney damage. Quantitative analysis and follow-up reveal declining renal function, especially with moderate bacteriuria, indicating potential for worsening renal damage.
Area of Science:
- Pediatric Nephrology
- Nuclear Medicine
- Radiology
Background:
- Pyelonephritis in children can lead to progressive renal damage.
- Early identification of at-risk children is crucial for timely intervention.
- Assessing renal function post-pyelonephritis requires sensitive diagnostic tools.
Purpose of the Study:
- To develop a system for identifying children at risk of progressive renal damage.
- To evaluate the utility of Tc-99m DMSA scintigraphy in assessing renal damage progression.
- To correlate scintigraphic findings with clinical and laboratory data.
Main Methods:
- Tc-99m DMSA scintigraphy was performed on 34 children during acute pyelonephritis, at 6 months, and 1 year.
- Parenchymal defects and kidney activity uptake (KU/AD) were analyzed.
- Scintigraphic findings were correlated with clinical and laboratory data, including urine cultures.
Main Results:
- Parenchymal defects were present in all children acutely; 66% improved by 6 months, but new defects appeared in 22% and 34% at 6 months and 1 year, respectively.
- Mean kidney activity uptake (KU/AD) increased from the acute stage to 6 months, with no significant further increase at 1 year.
- Children with moderate bacteriuria (> or = 104 bacteria/ml) showed decreased KU/AD, while those with lower counts (< 104 bacteria/ml) had increased KU/AD.
Conclusions:
- Quantitative Tc-99m DMSA scintigraphy enhances sensitivity for detecting renal damage.
- Follow-up scintigraphy identifies children with declining renal tubular function at risk for progressive damage.
- Moderate bacteriuria is linked to deterioration of renal tubular function, highlighting a risk factor for worsening kidney damage.
Purpose:
The author's goal was to create a system to identify children at risk for development of progressive renal damage.
Methods:
Thirty-four children were examined with Tc-99m DMSA scintigraphy in the acute stage of an initial episode of pyelonephritis, after 6 months, and again after 1 year. The scintigraphic findings were correlated with clinical and laboratory data.
Results:
All children had parenchymal defects in the acute stage: 93% of the kidneys and 85% bilaterally. After 6 months, the defects had diminished or disappeared in 66% of the kidneys. New defects appeared in 22%. At 1 year, no further improvement was seen in the kidneys, with an improved or unchanged pattern at 6 months. New defects appeared in 34%. Mean kidney activity uptake expressed as the percentage of administered dose (KU/AD), was low in the acute stage, increased at 6 months, with no further significant increase at 1 year. Eighty-three percent of children with urine cultures growing > or = 104 bacteria/ml at follow-up had decreased KU/AD values, whereas all children with urine cultures growing < 104 bacteria/ml had increased KU/AD values.
Conclusions:
Quantitative assessment increases the sensitivity of Tc-99m DMSA scintigraphy. Follow-up with this method makes it possible to identify the children with decreasing renal tubular function who may be at risk for progressive renal damage. Moderate bacteruria of 104 bacteria/ml urine is associated with deterioration of renal tubular function.
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