Dimercapto-succinic acid scintigraphy instead of voiding cystourethrography for infants with urinary tract infection.
OBJECTIVE
We study the ability of dimercapto-succinic acid (DMSA) scintigraphy to predict the presence of dilating vesicoureteral reflux (VUR) in infants with urinary tract infection (UTI) to simplify the evaluation protocol.


METHODS
A retrospective analysis of the records of 303 children younger than 2 years with initial UTI investigated with DMSA scintigraphy and voiding cystourethrography (VCU) within 3 months after UTI was performed.


RESULTS
In 156 of the 303 children (51%) DMSA scintigraphy showed renal lesions. VUR was found in 80 patients (26%) and VUR grade significantly correlated with the presence of renal lesions. A normal DMSA scintigraphy and dilating VUR (grade III) occurred in 7 infants. At followup after 1 to 2 years, 6 of these 7 patients had normal DMSA scans and 1 had a scarred duplex kidney. VUR resolved spontaneously in 5 and improved spontaneously to grade 1 in 2 patients. None of the 7 children had recurrent UTI.


CONCLUSIONS
DMSA scintigraphy in infants with UTI may replace VCU as a first line investigation. A strategy to perform VCU in only patients with renal lesions is proposed. In this study 147 of 303 VCUs would have been unnecessary as only 1 child with a damaged kidney was missed.
Departments of Pediatrics, Göteborg University, The Queen Silvia Children's Hospital, SE-416 85 Göteborg, Sweden. sverker.hansson@pediat.gu.se
Sverker
S
Hansson
Manjit
M
Dhamey
Olof
O
Sigström
Rune
R
Sixt
Eira
E
Stokland
Martin
M
Wennerström
Ulf
U
Jodal
D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007668:Kidney / Q000000981:diagnostic imaging*; D008297:Male; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D014552:Urinary Tract Infections / Q000150:complications / Q000000981:diagnostic imaging*; D014567:Urography; D014718:Vesico-Ureteral Reflux / Q000150:complications / Q000000981:diagnostic imaging*
D019275:Radiopharmaceuticals; D019783:Technetium Tc 99m Dimercaptosuccinic Acid