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Renal scarring secondary to vesicoureteric reflux. Critical assessment and new grading

M Monsour1, A F Azmy, J R MacKenzie

  • 1Department of Paediatric Surgery, Royal Hospital for Sick Children, Glasgow.

British Journal of Urology
|October 1, 1987
PubMed

Insights

Dimercaptosuccinic acid (DMSA) scans are most accurate for detecting early kidney scars in young children with urinary tract infections. Ultrasound is also effective, with all methods showing similar sensitivity in older children.

Area of Science:

  • Pediatric Nephrology
  • Diagnostic Imaging
  • Urology

Background:

  • Urinary tract infections (UTIs) are common in children and can lead to renal scarring.
  • Early detection of renal scarring is crucial to prevent long-term kidney damage.
  • Vesicoureteric reflux is a significant risk factor for UTIs and subsequent renal scarring.

Purpose of the Study:

  • To evaluate the sensitivity of renal ultrasound (U/S), intravenous urography (IVU), and dimercaptosuccinic acid (99mTc DMSA) scans in detecting renal scarring in children with UTIs.
  • To determine the pick-up rate of renal scarring secondary to vesicoureteric reflux using these imaging modalities.
  • To introduce a new grading system for the severity of renal scarring.

Main Methods:

  • Retrospective analysis of 150 children diagnosed with proven UTIs.
  • Detailed assessment of 63 children who underwent U/S, IVU, and DMSA scans within a 6-month period.
  • Comparison of the sensitivity and pick-up rates of each imaging technique for renal scarring.

Main Results:

  • Dimercaptosuccinic acid (DMSA) scans demonstrated the highest accuracy in detecting early renal scars in children aged 0-2 and 2-5 years.
  • Ultrasound (U/S) was the second most sensitive method for detecting early renal scars.
  • Renal ultrasound, IVU, and DMSA scans showed comparable sensitivity in children over 5 years of age.

Conclusions:

  • DMSA scan is the preferred imaging modality for early detection of renal scarring in young children with UTIs.
  • Ultrasound is a valuable alternative, especially in older children.
  • A novel grading system for renal scarring severity has been developed and presented.

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