Radionuclide assessment of patients with urinary tract infection and vesico-ureteric reflux using tc-99m-dimercaptosuccinic Acid.
The purpose of this study was to evaluate pediatric patients with urinary tract infection and to identify the risk of developing renal scarring and its relationship to the presence of vesico-ureteric reflux. The subjects in this study were 29 pediatric patients between two months and 11 years of age with a history of urinary tract infection among which 69% were females. All the patients underwent radio-isotope scanning using Technetium-99-m-dimercaptosuccinic acid, 4-6 weeks after the eradication of the acute infection. Micturating cysto-urethrography and renal ultrasound examinations were performed before the radio-isotope scanning. Isotope scanning showed evidence of scarring in 34% of the kidneys, while ultrasound scanning was positive in only 29% of the kidneys. The agreement between the results of the two examinations was in 88% of the kidneys. Reflux was noted in 53% of the kidneys of which 62% showed scarring by isotope scanning. Only 11% of the kidneys with no reflux showed evidence of scarring, while 92% of kidneys with severe reflux had renal scarring. In patients with reflux, 57% of the kidneys in female patients and 50% of the kidneys in male patients developed renal scarring evident on DMSA scanning. Absence of reflux had a high predictive value for absence of renal scarring, while the presence of reflux did not necessarily imply the presence of renal scarring but the possibility increased with the severity of reflux.
Al-Kaylani
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Department of Diagnostic Radiology, King Hussein Medical Center, Amman, Jordan.