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Cortical scintigraphy in the evaluation of renal parenchymal changes in children with pyelonephritis
D Benador1, N Benador, D O Slosman
1Department of Pediatrics, Hôpital Cantonal Universitaire de Geneve, Switzerland.
Insights
Dimercaptosuccinic acid (DMSA) scintigraphy is more effective than ultrasonography in detecting kidney damage in children with pyelonephritis. This imaging technique should be considered for initial diagnosis in pediatric cases.
Area of Science:
- Pediatric Nephrology
- Diagnostic Imaging
- Infectious Diseases
Background:
- Pyelonephritis is a common kidney infection in children.
- Early detection of renal parenchymal lesions is crucial for preventing long-term complications.
- Current diagnostic methods have varying sensitivities in identifying these lesions.
Purpose of the Study:
- To prospectively compare the efficacy of dimercaptosuccinic acid (DMSA) cortical scintigraphy and ultrasonography.
- To evaluate their ability to detect renal parenchymal lesions in pediatric patients diagnosed with pyelonephritis.
Main Methods:
- Prospective study including 111 children (1 week to 16 years) with culture-positive pyelonephritis.
- DMSA cortical scintigraphy and ultrasonography performed on all patients.
- Repeat imaging in 25 children after a mean follow-up of 10.5 months.
Main Results:
- DMSA scintigraphy detected renal changes in 67% of children, significantly higher than ultrasonography (35%, p < 0.001).
- Discordant results between the two methods were observed in 49 patients.
- Children over 1 year old showed a higher incidence of renal lesions (85% vs. 66%).
- Inflammatory markers showed 89% sensitivity and 25% specificity for renal lesions.
- Vesicoureteric reflux was present in 39% of children with renal changes.
- Renal scarring was identified in 64% of children at follow-up.
Conclusions:
- Pyelonephritis in children frequently leads to renal involvement and potential scarring.
- DMSA cortical scintigraphy demonstrates superior sensitivity compared to ultrasonography for detecting renal changes in pediatric pyelonephritis.
- DMSA scintigraphy is recommended as an addition to the initial diagnostic workup for suspected pyelonephritis in children.
Abstract:
We designed a prospective study to evaluate the ability of dimercaptosuccinic acid cortical scintigraphy and ultrasonography to detect renal parenchymal lesions in children with pyelonephritis. One hundred eleven patients 1 week to 16 years of age (median 5.5 months) with a urine culture positive for pathogens were included in the study; cortical scintigraphy and ultrasonography were repeated in 25 children after a mean follow-up of 10.5 months. Cortical scintigraphy showed renal changes in 74 children (67%), and ultrasonography showed renal changes in 39 (35%) (p < 0.001); results of the two examinations were discordant in 49 patients (kappa = 0.19). Children more than 1 year of age had a higher incidence of renal lesions than did younger children (85% vs 66%; p = 0.04). The presence of inflammatory signs (erythrocyte sedimentation rate or C-reactive protein) had an 89% sensitivity and a 25% specificity in identifying renal lesions. Among children with renal changes, vesicoureteric reflux was present in 39%. At follow-up examination, 16 children (64%) had scars. Thus we found a high incidence of renal involvement in children with pyelonephritis. We found that cortical scintigraphy is more sensitive than ultrasonography in detecting renal changes, and we believe that it should be added to the initial examination of children with suspected pyelonephritis.