Functional parameters and 99mtechnetium-dimercaptosuccinic acid scan in acute pyelonephritis

Area of Science:

• Pediatric Nephrology
• Diagnostic Imaging
• Biomarkers in Urology

Background:

• Acute pyelonephritis (APN) is a common kidney infection in children.
• Accurate diagnosis is crucial to prevent renal scarring and long-term complications.
• Current diagnostic methods have limitations, especially in infants.

Purpose of the Study:

• To evaluate the diagnostic value of 99mtechnetium-dimercaptosuccinic acid (DMSA) scintigraphy, ultrasonography, and renal functional parameters in children with first-time APN.
• To compare diagnostic utility across different age groups (infants vs. older children).

Main Methods:

• 39 children with first-time urinary tract infection underwent ultrasonography and DMSA scintigraphy.
• Urine N-acetyl-beta-D-glucosaminidase (NAG)/creatinine and albumin/creatinine quotients were measured.
• Data were analyzed for correlation with APN diagnosis and DMSA findings.

Main Results:

• DMSA scintigraphy revealed uptake defects in 82% of patients, confirming APN.
• Ultrasonography showed abnormalities in 31% of patients.
• Urine NAG/creatinine and albumin/creatinine quotients were elevated in APN, particularly in children under 1 year, and correlated with DMSA scores in this group.

Conclusions:

• DMSA scintigraphy is a sensitive tool for confirming APN in children.
• Ultrasonography has lower sensitivity for detecting APN-related renal changes.
• Early measurement of urine NAG/creatinine and albumin/creatinine quotients shows promise for improving APN diagnostics in infants.