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Early 99mTc dimercaptosuccinic acid (DMSA) scintigraphy in symptomatic first-time urinary tract infection
E Stokland1, M Hellström, B Jacobsson
1Department of Paediatric Radiology, East Hospital, Göteborg University, Sweden.
Insights
99mTc dimercaptosuccinic acid (DMSA) scintigraphy can detect kidney damage in children with urinary tract infections. Early DMSA scans, within days of treatment, are crucial for identifying renal involvement and guiding care.
Area of Science:
- Pediatric Nephrology
- Nuclear Medicine
- Infectious Diseases
Background:
- Urinary tract infections (UTIs) are common in young children.
- Assessing renal scarring and involvement is critical for appropriate management.
- 99mTc dimercaptosuccinic acid (DMSA) scintigraphy is a key imaging modality.
Purpose of the Study:
- To evaluate the utility of DMSA scintigraphy in identifying renal involvement in children with symptomatic UTIs.
- To determine the optimal timing for DMSA scintigraphy after UTI treatment initiation.
Main Methods:
- A prospective study of 175 children under 6 years with symptomatic UTIs.
- 99mTc dimercaptosuccinic acid (DMSA) scintigraphy performed at a median of 10 days post-treatment initiation.
- Correlation analysis with C-reactive protein and reflux grade.
Main Results:
- 42% of children showed abnormal DMSA findings, indicating renal scarring.
- Abnormalities decreased within 14 days of treatment initiation.
- C-reactive protein and reflux grade significantly correlated with abnormal DMSA results.
Conclusions:
- DMSA scintigraphy is valuable for demonstrating renal involvement in acute UTIs.
- Performing DMSA scintigraphy within days of treatment start is recommended.
- Vesicoureteral reflux was present in less than half of affected renal units with abnormal DMSA findings.
Abstract:
During a 2 year period, 175 children below 6 years of age (median 0.4 year) with non-obstructive symptomatic urinary tract infection were studied by 99mTc dimercaptosuccinic acid (DMSA) scintigraphy. DMSA scintigraphy was performed at a median of 10 days after the start of treatment and was abnormal in 73 children (42%), equivocal in 29 (16%) and normal in 73 (42%). Reflux was seen in 27% of all children and in 38% of the renal units that were abnormal at DMSA scintigraphy. A decreasing frequency of abnormalities at DMSA scintigraphy was seen within the first 14 days after the start of treatment. C-reactive protein and grade of reflux correlated significantly with abnormal DMSA studies. To demonstrate renal involvement in acute urinary tract infection, DMSA scintigraphy should be performed within days after the start of treatment. It is noteworthy that reflux was seen in less than half of renal units with abnormal DMSA scintigraphy.