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Kidney swelling. Findings on DMSA scintigraphy

L Wallin1, I Helin, M Bajc

  • 1Department of Clinical Physiology, Lund University Hospital, Sweden.

Clinical Nuclear Medicine
|May 1, 1997
PubMed
Summary

Swollen kidneys on dimercaptosuccinic acid (DMSA) scans can indicate acute pyelonephritis. New criteria help identify swelling by measuring kidney size and radioactive uptake, aiding diagnosis even without clear symptoms.

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Area of Science:

  • Pediatric Nephrology
  • Nuclear Medicine
  • Radiology

Background:

  • Acute pyelonephritis is a common kidney infection in children.
  • Dimercaptosuccinic acid (DMSA) renal scintigraphy is crucial for diagnosing pyelonephritis.
  • Identifying kidney swelling on DMSA scans is important for accurate diagnosis and management.

Purpose of the Study:

  • To establish criteria for detecting swollen kidneys in acute pyelonephritis using DMSA scintigraphy.
  • To correlate DMSA distribution patterns, kidney size, and radioactive uptake with kidney swelling.

Main Methods:

  • Evaluated 94 DMSA scintigrams from 38 children (15 days to 7 years) with pyelonephritis.
  • Defined qualitative and quantitative criteria to assess kidney swelling.
  • Analyzed kidney size (length, width/length) and radioactive uptake (percent injected dose, uptake/background).

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Main Results:

  • Thirty-one kidneys met the swelling criteria.
  • Swollen kidneys showed increased length and width/length.
  • Swollen kidneys had lower radioactive uptake and uptake/background ratios.
  • Swelling sometimes obscured focal defects, which reappeared on follow-up scans.
  • Reinfection was confirmed in 5 children with swelling on repeat imaging.

Conclusions:

  • Swollen kidneys on DMSA scans can be the sole indicator of acute pyelonephritis.
  • Kidney swelling may mask focal defects, necessitating careful evaluation.
  • Measuring kidney size and radioactive uptake aids in identifying swollen kidneys and diagnosing acute pyelonephritis, even with subtle clinical signs.