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Correlation of 99mTc-DMSA scan with radiological and laboratory examinations in childhood acute pyelonephritis: a

Khadijeh Ghasemi1, Sahar Montazeri, Ali Mahmoud Pashazadeh

  • 1Division of Nephrology, Department of Paediatrics, Bushehr Medical Center Hospital, Bushehr University of Medical Sciences, Bushehr, Iran.

International Urology and Nephrology
|June 4, 2013
PubMed

Insights

A 12-month follow-up renal scintigraphy with technetium-99m dimercaptosuccinic acid (99mTc-DMSA) scan is recommended for accurate diagnosis of permanent renal damage after acute pyelonephritis (APN) in children. This timing is more reliable than a 6-month scan for assessing long-term outcomes.

Area of Science:

  • Pediatric Nephrology
  • Nuclear Medicine
  • Infectious Diseases

Background:

  • Urinary tract infections (UTIs) are common in children and can lead to severe kidney complications.
  • Renal scintigraphy using technetium-99m dimercaptosuccinic acid (99mTc-DMSA) is crucial for diagnosing acute pyelonephritis (APN) and identifying renal scars.
  • Early detection and management of APN are vital to prevent long-term sequelae like hypertension and renal failure.

Purpose of the Study:

  • To determine the optimal timing for follow-up 99mTc-DMSA scans to accurately detect renal scarring post-APN.
  • To identify predictive factors for the development of permanent renal damage following an initial episode of APN in pediatric patients.
  • To compare the diagnostic yield of 6-month versus 12-month follow-up 99mTc-DMSA scans.

Main Methods:

  • Sixty-four children with a confirmed first episode of APN underwent an initial 99mTc-DMSA scan.
  • Patients with abnormal findings on the initial scan had repeat 99mTc-DMSA scans at 6 and 12 months post-infection.
  • Logistic regression analysis was employed to evaluate factors associated with permanent renal damage.

Main Results:

  • The initial 99mTc-DMSA scan revealed cortical abnormalities in 54.7% of children.
  • Follow-up scans at 6 and 12 months showed persistent cortical lesions in 39.06% and 32.8% of patients, respectively.
  • Patient age was the only significant independent predictor of permanent renal damage (p=0.01), while other factors like gender, treatment delay, and laboratory markers were not associated.

Conclusions:

  • There is no significant difference in detecting renal damage between 6-month and 12-month follow-up 99mTc-DMSA scans.
  • A 12-month follow-up 99mTc-DMSA scan is recommended for a more accurate assessment of permanent renal damage after APN in children.
  • Long-term monitoring is essential for pediatric patients who exhibit renal damage following APN.
Abstract

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