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Evaluation of DMSA scintigraphy and urography in assessing both acute and permanent renal damage in children
E Stokland1, M Hellström, B Jacobsson
1Department of Pediatric Radiology, Sahlgrenska University Hospital, Göteborg, Sweden.
Insights
Dimercaptosuccinic acid (DMSA) scintigraphy effectively identifies children at risk for kidney damage after urinary tract infections (UTI). Early DMSA findings help predict which patients may develop lasting renal damage.
Area of Science:
- Pediatric Nephrology
- Diagnostic Imaging
- Infectious Diseases
Background:
- Urinary tract infections (UTI) in children can lead to renal scarring and damage.
- Early detection of renal involvement is crucial for timely intervention and preventing long-term complications.
Purpose of the Study:
- To assess the efficacy of dimercaptosuccinic acid (DMSA) scintigraphy and urography in detecting renal involvement in children with UTI.
- To identify children at high risk of developing renal damage following a UTI.
Main Methods:
- 157 children with first-time symptomatic UTI underwent DMSA scintigraphy and urography at the time of infection and 1 year later.
- Evaluations were performed blindly, assessing renal area involvement and split renal function.
Main Results:
- Initial DMSA scintigraphy revealed abnormalities in 25% of kidneys; 55% of these normalized at follow-up.
- Follow-up scintigraphy showed abnormalities in 12% of initially normal kidneys.
- One year post-UTI, 59 children had scintigraphic abnormalities, while 18 had urographic abnormalities.
Conclusions:
- Quantifying renal area involvement and split renal function via early DMSA scintigraphy aids in identifying children at risk for renal damage.
- Urography at 1 year post-infection primarily identified severe scintigraphic abnormalities.
- The clinical significance of DMSA abnormalities not confirmed by urography requires further investigation.
Purpose:
To evaluate dimercaptosuccinic acid (DMSA) scintigraphy and urography in the detection of renal involvement in children with urinary tract infection (UTI) in order to identify patients with a high risk of developing renal damage.
Material And Methods:
A total of 157 children (median age 0.4 years, range 5 days to 5.8 years) with first-time symptomatic UTI were examined scintigraphy (with an assessment of renal area involvement) and urography at the time of UTI and 1 year later. All evaluations were made blindly.
Results:
Of the total 314 kidneys, 80 (25%) were abnormal at initial scintigraphy. Of these 80 kidneys, 44 (55%) had normalized at follow-up. Of the 234 initially normal kidneys, 29 (12%) were abnormal at follow-up. One year after UTI, abnormalities were seen in 59 children at scintigraphy and in 18 children at urography. Renal area involvement was larger and split function abnormalities more common in kidneys that were abnormal at both scintigraphy and urography than in kidneys with only scintigraphic abnormalities.
Conclusion:
Quantitation of renal area involvement and split renal function at early scintigraphy would seem to be useful in identifying patients at risk of developing renal damage. Urography at 1 year after infection identified mainly those with the most severe scintigraphic abnormalities. The clinical importance of scintigraphic abnormalities that are not confirmed by urography is not known.