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A prospective study of children with first acute symptomatic E. coli urinary tract infection. Early 99mtechnetium
D M Tappin1, A V Murphy, H Mocan
1Department of Nephrology, Royal Hospital for Sick Children, Glasgow, Great Britain.
Insights
Early dimercaptosuccinic acid (DMSA) scans in children with urinary tract infections (UTIs) can identify renal parenchymal involvement. Diminished radionuclide uptake on initial DMSA scans correlates with infection severity and is more common in cases with vesicoureteral reflux (VUR).
Area of Science:
- Pediatric Nephrology
- Diagnostic Imaging
- Infectious Diseases
Background:
- Urinary tract infections (UTIs) are common in children, with potential for renal scarring.
- Early diagnosis and management are crucial to prevent long-term kidney damage.
- Assessing renal involvement in pediatric UTIs requires accurate imaging techniques.
Purpose of the Study:
- To evaluate the utility of early 99mtechnetium dimercaptosuccinic acid (DMSA) scans in identifying renal parenchymal involvement in children with acute symptomatic UTIs.
- To determine the association between early DMSA scan findings and clinical presentation, vesicoureteral reflux (VUR), and subsequent renal scarring.
Main Methods:
- A cohort of 102 children (age 0-14 years) with first acute symptomatic UTIs were investigated.
- Investigations included early DMSA scans, ultrasonography, micturating cysto-urethrography, and indirect voiding radionuclide cystography.
- Follow-up DMSA scans were performed after 6 months.
Main Results:
- Twenty-one of 102 initial DMSA scans showed diminished radionuclide uptake, and 12 showed cortical scarring.
- Twenty-nine patients had significant VUR.
- Diminished uptake on initial DMSA scans was significantly associated with fever, systemic upset, symptom duration, and leukocytosis (p < 0.05).
- Diminished uptake and scarring were more frequent in kidneys with VUR.
Conclusions:
- Early DMSA scan findings of diminished radionuclide uptake can localize infection to the renal parenchyma in children with UTIs.
- These findings suggest early DMSA scanning is valuable for assessing the severity and extent of renal involvement in pediatric UTIs.
- The association with VUR highlights the importance of evaluating for reflux in children with evidence of pyelonephritis on DMSA scans.
Abstract:
Between 1985 and 1987 102 children, age 0-14 years, presented with a first acute symptomatic E. coli urinary tract infection. Investigations included early 99mtechnetium dimercaptosuccinic acid (DMSA) scan (which was performed at a median of 27 days), ultrasonography, micturating cysto-urethrography and indirect voiding radionuclide cystography using 99mTc DTPA. Follow-up DMSA scan was carried out after 6 months. Twenty-one of 102 of initial DMSA studies showed diminished uptake of radionuclide and 12 showed cortical scarring. Twenty-nine patients had significant vesicoureteral reflux (VUR). The finding of diminished uptake on the initial scan was significantly associated with fever, systemic upset, length of symptoms and a peripheral blood leucocytosis, (p less than 0.05). In addition the finding was associated with fever and loin pain in the older child. Both diminished uptake and scarring were more common in refluxing kidney units. We propose that, in children with UTI, diminished uptake on early DMSA scan localises infection in the renal parenchyma.