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Can ultrasound reliably detect renal scarring in children with urinary tract infection?

A D Tasker1, D R Lindsell, M Moncrieff

  • 1Department of Radiology, John Radcliffe Hospital, Oxford.

Clinical Radiology
|March 1, 1993
PubMed

Insights

Ultrasound (US) is not reliable for detecting kidney scarring in children with urinary tract infections. 99mTc dimercaptosuccinic acid (DMSA) scintigraphy is essential for accurate diagnosis and should supplement US imaging.

Area of Science:

  • Pediatric Nephrology
  • Diagnostic Imaging
  • Infectious Diseases

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.
  • Ultrasound (US) is a widely used imaging modality, but its efficacy in detecting scarring is debated.

Purpose of the Study:

  • To prospectively evaluate the diagnostic accuracy of ultrasound (US) in detecting renal scarring.
  • To compare the efficacy of US with 99mTc dimercaptosuccinic acid (DMSA) scintigraphy in identifying renal scars post-UTI.

Main Methods:

  • One hundred children with confirmed UTIs underwent both US and 99mTc DMSA scintigraphy.
  • Renal scarring was classified as mild, moderate, or gross based on DMSA findings.
  • Sensitivity of US in detecting DMSA-identified scars was calculated.

Main Results:

  • 99mTc DMSA scintigraphy identified 19 scarred kidneys in 17 children.
  • Ultrasound detected only 7 of the 19 scarred kidneys, yielding a sensitivity of 37%.
  • US missed all cases of mild scarring and most moderate scarring, while detecting only gross scarring.

Conclusions:

  • Ultrasound alone is insufficient for reliably detecting renal scarring in children with UTIs.
  • Significant discrepancies exist between US and DMSA findings, with US often failing to identify scars.
  • 99mTc DMSA scintigraphy remains the gold standard and should be used adjunctively with US for comprehensive assessment.

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