[Diagnosis of acute pyelonephritis in childhood: comparison of ultrasonographic examination and renal scintigraphy using 99mTc DMSA].
THE CURRENT STATE: Infections of the urinary tract are a frequent paediatric problem. Their treatment requires to assess the localisation of infection within the uropoetic tract. Especially the acute pyelonephritis (AP) can lead to irreversible changes within the renal parenchyma and alteration of renal functions. Some imaging examinations can help in the assessment of the diagnosis of AP and contribute to appropriate therapy.
The analysis of results gained from imaging examinations in children with AP was based on the comparison of used techniques and the assessment of their exploitation for the diagnosis of AP.


METHODS
38 children (17 girls and 21 boys at average age of 11.6 years) with clinical criteria of AP were subdued to ultrasonographic examination with B record (US-B) and ultrasonographic examination with energetic Doppler (US-D). Both methods were compared with the findings gained by use of renal scintigraphy 99mTc DMSA.


RESULTS
The positive finding of AP was proved in 36 children (94.7%). The results of US-B proved AP in 14 children (36.8%) of the whole group of patients, i.e. in 38.8% with positive DMSA finding. US-D changes indicated AP in 15 children (39.4%) of the whole group, i.e. in 41.6% with positive DMSA finding. The sensitivity of both methods US-B and US-D appear to be low for the verification of changes in renal parenchyma in AP.


CONCLUSIONS
Despite its advantages and availability, the gain from ultrasonographic examination in children suffering from AP is small. Clinical and laboratory criteria are fully sufficient for AP verification in common clinical practice. DMSA scintigraphy is a method of choice in complicated cases of AP. (Tab. 1, Ref. 17.)
Dolezel
Z
Z
IInd Dpt of Pediatry, Faculty of Medicine, Masaryk University, Cernopolni 9, CZ-662 63 Brno, Czech Republic. zdolezel@med.muni.cz
Mach
V
V
Kopecna
L
L
Starha
J
J
Dostalkova
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D
D000208:Acute Disease; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging*; D008297:Male; D011704:Pyelonephritis / Q000000981:diagnostic imaging*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D018608:Ultrasonography, Doppler
D019275:Radiopharmaceuticals; D019783:Technetium Tc 99m Dimercaptosuccinic Acid