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The detection of reflux nephropathy in infants by 99mtechnetium dimercaptosuccinic acid studies

R H Farnsworth1, M A Rossleigh, D M Leighton

  • 1Department of Urology, Prince Henry Hospital, Sydney, Australia.

The Journal of Urology
|March 1, 1991
PubMed

Insights

Dimercaptosuccinic acid (DMSA) scans are more sensitive than IVP for detecting renal scarring in infants. Abnormalities can occur even without infection, particularly with high-grade vesicoureteral reflux.

Area of Science:

  • Pediatric Nephrology
  • Diagnostic Imaging
  • Urology

Background:

  • Renal scarring in infants can lead to long-term complications.
  • Early detection of renal abnormalities is crucial for timely intervention.

Purpose of the Study:

  • To compare the diagnostic accuracy of Dimercaptosuccinic acid (DMSA) scintigraphy and excretory urography (IVP) in infants at risk of renal scarring.
  • To evaluate the correlation between DMSA findings, urinary tract infections (UTIs), and vesicoureteral reflux (VUR).

Main Methods:

  • A cohort of 113 infants under 1 year old underwent DMSA studies.
  • Voiding cystourethrography (VCUG) was performed in all infants.
  • Excretory urography (IVP) was performed in 99 infants.
  • DMSA findings were compared with VCUG and IVP results, and clinical data (UTI, fever).

Main Results:

  • DMSA identified more renal abnormalities than IVP.
  • Excellent site-by-site correlation was observed when both DMSA and IVP were abnormal.
  • Fever or systemic illness did not reliably predict upper tract infection.
  • Abnormal DMSA findings increased with high-grade VUR and decreased with low-grade VUR.
  • Renal scarring occurred in both infected and non-infected infants, suggesting sterile reflux can cause scarring.

Conclusions:

  • DMSA scintigraphy is a more sensitive tool than IVP for detecting renal scarring in infants.
  • Renal scarring can occur in the absence of infection, particularly in infants with high-grade VUR.
  • DMSA findings correlate well with VUR grade and can identify abnormalities missed by IVP.

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