title: The role of DMSA renal scintigraphy in the first episode of urinary tract infection in childhood.
abstract: OBJECTIVE
  The role of dimercaptosuccinic acid (DMSA) renal scintigraphy in the first episode of urinary tract infection (UTI) has been the subject of debate for many years. The aim of this study was to evaluate the relationship of voiding cystourethrography (VCUG), renal ultrasonography and DMSA renal scintigraphy and to detect renal parenchymal changes by performing DMSA renal scintigraphy at 6 months after the first episode of UTI.
  
  
  METHODS
  A prospective study was conducted in 67 hospitalized children (46 boys, 21 girls). Mean age of the patients was 0.97 ± 1.57 years (0.02-7.26 years). All children received VCUG, renal ultrasonography and DMSA renal scintigraphy. DMSA renal scintigraphy was performed at 1 and 6 months after UTI.
  
  
  RESULTS
  Of 67 children, 17 (25.4%), 23 (34.3%) and 20 (29.9%) had vesicoureteral reflux (VUR), abnormal renal ultrasonography and abnormal DMSA renal scintigraphy, respectively. Unilateral hydronephrosis had a significant correlation with VUR at p value 0.024. In renal units, abnormal renal ultrasonography and hydronephrosis had significant correlations with VUR at p values 0.039 and 0.021, respectively. In patients and renal units, hydronephrosis had no significant correlation with abnormal DMSA renal scintigraphy at 1 month after UTI. However, abnormal renal ultrasonography and VUR had significant correlations with abnormal DMSA renal scintigraphy at p values 0.022 and < 0.001 in patients and at p values 0.024 and < 0.001 in renal units, respectively. Both in patients and renal units, VUR (Grade I-III) had no significant correlation with abnormal DMSA renal scintigraphy. However, severe VUR (Grade IV-V) had significant correlations with abnormal DMSA renal scintigraphy at p values < 0.001 and < 0.001, respectively. Seventeen patients underwent DMSA renal scintigraphy at 6 months after UTI. In addition, 15 (88.2%) developed persistent renal scarring.
  
  
  CONCLUSIONS
  Abnormal renal ultrasonography and severe VUR identify renal parenchymal changes. DMSA renal scintigraphy in the first episode of UTI should be carried out in those patients. Abnormal DMSA renal scintigraphy at 1 month after UTI has a tendency to persist.
authors.affiliation: Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand. ssupavekin@yahoo.com
authors.forename: Suroj
authors.initials: S
authors.lastname: Supavekin
authors.forename: Wantanee
authors.initials: W
authors.lastname: Surapaitoolkorn
authors.forename: Nantiya
authors.initials: N
authors.lastname: Pravisithikul
authors.forename: Siwinee
authors.initials: S
authors.lastname: Kutanavanishapong
authors.forename: Sunanta
authors.initials: S
authors.lastname: Chiewvit
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007668:Kidney / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D011877:Radionuclide Imaging; D004113:Succimer; D013997:Time Factors; D014463:Ultrasonography; D014552:Urinary Tract Infections / Q000000981:diagnostic imaging* / Q000503:physiopathology
chemical_list: D004113:Succimer