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The DMSA scan in paediatric urinary tract infection
1British Columbia's Children's Hospital, Vancouver, Canada.
Insights
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.
Abstract:
The objective of the present paper was to review the use of the dimercaptosuccinic acid (DMSA) scan in urinary tract infection at British Columbia's Children's Hospital to determine the frequency of cortical defects and the association between vesico-ureteric reflux and the presence of cortical defects in children with urinary tract infection. A total of 129 consecutive children with a urinary tract infection referred for a DMSA scan in a 2-year period (January 1992-January 1994) were retrospectively studied. The results were analysed in terms of kidneys, and the incidence of cortical defects was determined. Eighty-eight patients (68%) had a radiographic micturating cysto-urethrogram within 6 months of the DMSA scan, and in this group the relationship of defects with vesico-ureteric reflux was determined. Overall, 81/258 (31%) of kidneys had a cortical defect on a DMSA scan. Of those who had a micturating cysto-urethrogram, 53/176 (30%) kidneys had vesico-ureteric reflux, and of those that had reflux, 21/53 (40%) had a cortical defect on a DMSA scan. In the group of children without reflux, 38/123 (31%) had a cortical defect. Renal cortical scan defects are common findings in paediatric urinary infection, and frequently occur in the absence of vesico-ureteric reflux. These defects represent either established scars or acute pyelonephritis that can proceed to scarring. The micturating cysto-urethrogram alone is insufficient as a screening modality to identify those kidneys at risk of renal scarring.