title: Does severity of renal scarring on DMSA scan predict abnormalities in creatinine clearance?
abstract: OBJECTIVE
  To examine the relationship between severity of renal scarring and creatinine clearance. Existing studies on renal scarring and functional outcomes have focused on the presence or absence of scarring.
  
  
  METHODS
  Patients with a history of urinary tract infection leading to the diagnosis of vesicoureteral reflux were recruited. These subjects were admitted to a pediatric research center for an in-patient collection of 24-hour urine to be sent for creatinine and protein. DMSA scans performed at least 6 months after documented urinary tract infection were graded by 3 independent, blinded pediatric urologists for renal scarring according to the Randomized Intervention for Children with Vesicoureteral Reflux study criteria.
  
  
  RESULTS
  Twenty-nine subjects (14 girls, 15 boys) with a median age of 7 years were recruited. Scar grading was reliable between the observers with a Kappa score of 0.66-0.75. On DMSA scan, 10% were scar-free, 62% had unilateral scars, and 28% had bilateral scars. Mean creatinine clearance was 123 for those with unilateral disease and 100 for those with bilateral disease (P = .048). Median proteinuria (58 mg/dL) and serum creatinine (0.5 mg/dL) were similar between the 2 groups. Creatinine clearance did not differ according to average scar grade, taking both kidneys into account.
  
  
  CONCLUSIONS
  In children with vesicoureteral reflux, although those with bilateral scarring have a significantly lower creatinine clearance than those with unilateral scarring, the severity of scar grade alone does not predict overall creatinine clearance with short-term follow-up.
authors.affiliation: Department of Urology, University of California, San Francisco, USA.
authors.forename: Jenny H
authors.initials: JH
authors.lastname: Yiee
authors.forename: Michael
authors.initials: M
authors.lastname: DiSandro
authors.forename: Ming-Hsien
authors.initials: MH
authors.lastname: Wang
authors.forename: Adam
authors.initials: A
authors.lastname: Hittelman
authors.forename: Laurence S
authors.initials: LS
authors.lastname: Baskin
mesh_terms: D002648:Child; D002675:Child, Preschool; D002921:Cicatrix / Q000000981:diagnostic imaging* / Q000209:etiology; D003404:Creatinine / Q000652:urine*; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000000981:diagnostic imaging* / Q000209:etiology; D008297:Male; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012720:Severity of Illness Index; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D014718:Vesico-Ureteral Reflux / Q000150:complications
chemical_list: D019275:Radiopharmaceuticals; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D003404:Creatinine