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The DMSA scan in paediatric urinary tract infection
1British Columbia's Children's Hospital, Vancouver, Canada.
Australasian Radiology
|December 2, 1998
Summary
Dimercaptosuccinic acid (DMSA) scans frequently reveal kidney defects in children with urinary tract infections, even without vesico-ureteric reflux. These defects indicate potential scarring and highlight DMSA scan importance in pediatric UTI management.
Area of Science:
- Pediatric Nephrology
- Diagnostic Imaging
- Infectious Diseases
Background:
- Urinary tract infections (UTIs) are common in children and can lead to renal scarring.
- Dimercaptosuccinic acid (DMSA) scintigraphy is a key imaging modality for detecting pyelonephritis and renal scars.
- Vesico-ureteric reflux (VUR) has been traditionally associated with renal damage in UTIs.
Purpose of the Study:
- To review the utilization of DMSA scans in pediatric UTIs.
- To determine the frequency of cortical defects identified by DMSA scans.
- To assess the association between VUR and cortical defects in children with UTIs.
Main Methods:
- Retrospective study of 129 children with UTIs undergoing DMSA scans over a 2-year period.
- Analysis of DMSA scan results for the presence of renal cortical defects.
- Correlation of DMSA findings with micturating cysto-urethrogram (MCU) results in a subset of patients.
Main Results:
- Overall, 31% of kidneys evaluated with DMSA scans showed cortical defects.
- In children who also had an MCU, 30% had VUR, and 40% of those with VUR had cortical defects.
- Importantly, 31% of kidneys without VUR also exhibited cortical defects on DMSA scans.
Conclusions:
- Renal cortical defects are common in pediatric UTIs, as detected by DMSA scans.
- These defects can occur frequently even in the absence of VUR.
- DMSA scans are crucial for identifying kidneys at risk of scarring, and MCU alone is insufficient for screening.