title: Correlation of 99mTc-DMSA scan with radiological and laboratory examinations in childhood acute pyelonephritis: a time-series study.
abstract: BACKGROUND
  Urinary tract infections are one of the most common diseases in children. They may lead to hypertension and renal failure later in life. Renal scintigraphy with technetium-99m dimercaptosuccinic acid (99mTc-DMSA) is one method used to diagnose acute pyelonephritis (APN) and renal parenchymal scars. The aim of the present study was to determine the ideal time to perform a follow-up 99mTc-DMSA scan to detect renal scars and also to evaluate the factors predicting the development of permanent renal damage after APN.
  
  
  METHODS
  Sixty-four children with a first episode of APN underwent a 99mTc-DMSA scan. If there were abnormal findings on this scan, another scan was performed 6 and 12 months later.
  
  
  RESULTS
  The baseline 99mTc-DMSA scan showed cortical changes in 35 patients (54.7 %). One the 6- and 12-month follow-up scans, 25 patients (39.06 %) and 21 patients (32.8 %), respectively, had cortical lesions. In multiple logistic regressions with the final 99mTc-DMSA scan results as the dependent variable, only the age range of the patients (β = 1.062; 95 % CI 1.014-1.113; p = 0.01) showed an independent and significant association. Gender, therapeutic delay time, ultrasonography, and voiding cystourethrogram results, as well as laboratory test results including the erythrocyte sedimentation rate, C-reactive protein level, white blood cell counts, and type of bacteria in the urine, did not show such an association (p > 0.05).
  
  
  CONCLUSIONS
  There is not a significant difference between the results of 6- and 12-month 99mTc-DMSA follow-up scans. A follow-up 99mTc-DMSA scan should be performed 12 months after the acute scan to yield a more accurate diagnosis of permanent renal damage. If present, long-term follow-up of patients is necessary.
authors.affiliation: Division of Nephrology, Department of Paediatrics, Bushehr Medical Center Hospital, Bushehr University of Medical Sciences, Bushehr, Iran.
authors.forename: Khadijeh
authors.initials: K
authors.lastname: Ghasemi
authors.forename: Sahar
authors.initials: S
authors.lastname: Montazeri
authors.forename: Ali Mahmoud
authors.initials: AM
authors.lastname: Pashazadeh
authors.forename: Hamid
authors.initials: H
authors.lastname: Javadi
authors.forename: Majid
authors.initials: M
authors.lastname: Assadi
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis / Q000378:metabolism; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods*; D015999:Multivariate Analysis; D011446:Prospective Studies; D011704:Pyelonephritis / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000209:etiology; D011877:Radionuclide Imaging; D018570:Risk Assessment; D012720:Severity of Illness Index; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D013997:Time Factors; D018608:Ultrasonography, Doppler; D014552:Urinary Tract Infections / Q000150:complications* / Q000175:diagnosis
chemical_list: D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D002097:C-Reactive Protein