Evaluation of DMSA scintigraphy and urography in assessing both acute and permanent renal damage in children.
OBJECTIVE
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.


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.


CONCLUSIONS
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.
Department of Pediatric Radiology, Sahlgrenska University Hospital, Göteborg, Sweden.
E
E
Stokland
M
M
Hellström
B
B
Jacobsson
U
U
Jodal
R
R
Sixt
D000208:Acute Disease; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D015902:Gamma Cameras; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007668:Kidney / Q000002:abnormalities / Q000000981:diagnostic imaging; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D018709:Statistics, Nonparametric; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D013997:Time Factors; D014552:Urinary Tract Infections / Q000000981:diagnostic imaging*; D014567:Urography
D019275:Radiopharmaceuticals; D019783:Technetium Tc 99m Dimercaptosuccinic Acid