Technetium 99m-dimercaptosuccinic acid (DMSA) scintigraphy has emerged as the imaging agent of choice for the detection and evaluation of acute pyelonephritis and renal cortical scarring in children. Consequently, DMSA scintigraphy provides a unique opportunity to study the progression of renal damage and functional loss from the initial insult of acute pyelonephritis to the subsequent development of irreversible renal scarring. Over the last few years, clinical and experimental investigations using DMSA renal scintigraphy have provided new insights into the etiology, pathophysiology, and clinical outcome of acute pyelonephritis in children. These studies have confirmed the primary role of the acute inflammatory response, associated with both reflux and nonreflux pyelonephritis, in the etiology of irreversible renal scarring. Furthermore, several studies have shown that renal scarring can be prevented or diminished by the early diagnosis and treatment of pyelonephritis. This review highlights these recent observations and makes recommendations regarding current clinical and future research applications.
Nocturnal enuresis is a symptom of environmental, physical, and psychosocial factors. In addition to a physical examination, the initial workup of the enuretic child should include a careful voiding, psychosocial, and family history. Studies have shown that the parents of enuretic children often have a history of enuresis. An increased incidence of enuresis has also been demonstrated in children from large families and lower socioeconomic groups. Daytime voiding symptoms (e.g., frequency, urgency, or enuresis) suggest the possibility of underlying voiding dysfunction. A complete urinalysis and urine culture also should be performed to exclude urinary infection and certain metabolic or nephrologic disorders. Finally, it is important that the treating physician understand the attitudes of both the child and the family concerning enuresis. Parents who feel that the child is at fault need to be educated and reassured. A careful, complete evaluation will allow the physician to tailor treatment to the individual child and family.
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