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Technetium-99m-DMSA studies in pediatric urinary infection
S E Clarke1, J M Smellie, N Prescod
1Department of Nuclear Medicine, Guy's Hospital, London, England.
Insights
Urinary tract infections (UTIs) in children can cause kidney damage. Abnormal 99mTc-DMSA scans strongly suggest vesico-ureteric reflux (VUR), a condition that may be preventable.
Area of Science:
- Pediatric Nephrology
- Diagnostic Imaging
- Urology
Background:
- Urinary tract infections (UTIs) are common in children and can lead to serious kidney complications.
- Renal scarring from UTIs may result in long-term hypertension and renal insufficiency.
- Early detection and management of UTI complications are crucial for preserving kidney function.
Purpose of the Study:
- To analyze findings from 99mTc-dimercaptosuccinic acid (DMSA) scans in children with symptomatic UTIs.
- To categorize DMSA scan results and establish a framework for further research.
- To investigate the relationship between DMSA findings, patient demographics, and history of UTI.
Main Methods:
- A cross-sectional study involving 496 children (157 males, 339 females) aged 0-14 years.
- Standard 99mTc-DMSA scintigraphy protocol was employed.
- Findings were classified based on image appearance and relative renal function, correlated with age, sex, UTI history, and micturating cysto-urethrography (MCU) results.
Main Results:
- Approximately half of the children had normal 99mTc-DMSA scans.
- Abnormal scans (equivocal, unilateral, or bilateral) were observed in the remaining children.
- No specific image changes were linked to acute UTI; however, abnormal scans were frequent in infant boys, girls with recurrent UTIs, and children with vesico-ureteric reflux (VUR).
- Bilateral abnormal images were almost exclusively associated with VUR (98%).
Conclusions:
- Infective renal changes in children may result from underlying congenital anomalies or develop secondary to UTIs in the presence of VUR.
- These renal complications associated with VUR are potentially preventable.
- Bilateral abnormal 99mTc-DMSA scans following UTI strongly indicate VUR, and unilateral defects are also commonly associated with VUR.
Unlabelled:
Urinary tract infection (UTI) is a common condition in children and may lead to renal scarring with a risk of later hypertension and renal insufficiency. We made a cross-sectional study of the 99mTc-DMSA findings in 496 children referred for following symptomatic UTI to a Department of Nuclear Medicine and we categorized the results, to provide a framework for further study.
Method:
A standard 99mTc-DMSA protocol was used to study 496 children (157 males, 339 females) aged from birth to 14 yr. Findings were classified according to the image appearance and relative function of each kidney. These were related to age, sex, history and timing of UTI and the results on micturating cysto-urethrography (MCU).
Results:
Images were normal, with function within limits (45%-50% in one kidney), in approximately half the boys and girls studied. The other images were classified as equivocal in 68 children, abnormal unilaterally in 105 and bilaterally in 76, and they were subdivided according to the image appearance. No image changes could be identified that were specifically associated with acute UTI. Diffuse change alone was uncommon. A high proportion of abnormal images was found in infant boys, older girls with recurrent UTI and those children with vesico-ureteric reflux (VUR). Of the bilateral abnormal images, 98% were seen in children with VUR.
Conclusion:
Our findings suggest that infective renal change may be superimposed on underlying congenital lesions (perhaps detectable antenatally) or may be acquired following UTI in the presence of reflux and are thus potentially preventable. This study also suggests that VUR is almost certain to have occurred in a child who has bilateral abnormal 99mTc-DMSA images following UTI and is also commonly present in those with definite unilateral defects.