Technetium-99m-DMSA studies in pediatric urinary infection

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.