Acute pyelonephritis and renal scarring in Kuwaiti children: a follow-up study using 99mTc DMSA renal scintigraphy

Abstract

The aim of this study was to determine the prevalence of renal scarring in a group of Kuwaiti Arab children with their first documented acute pyelonephritis (APN). Eighty-two Kuwaiti Arab children (10 males and 72 females) who had abnormal (99m)Tc DMSA renal scan findings of acute pyelonephritis were prospectively studied with the same imaging modality 6 months after treatment to identify those who developed renal scarring. A micturition cystourethrogram (MCUG) was performed for all of the children 1 month after diagnosis. Children were divided into 3 age groups (<2 years, 2-5 years and above 5 years). The follow-up DMSA renal scans 6 months after diagnosis revealed normalization of renal changes in 56% (46 patients), much improvement with residual renal abnormality in 6% (5 patients), and persistent parenchymal defects in 38% (31 patients). Vesicoureteric reflux (VUR) was found in 32% of children (26/82) and the majority were between grade I and III. Thirteen of those with VUR (50%) developed renal scars on follow-up. Fifty-three percent of the scarred kidneys (19/36) were drained by non-refluxing ureters. In this study, children older than 2 years had less VUR yet were more susceptible to APN and to the development of renal scars. Girls were more prone to developing APN and renal scarring than boys. This work shows that APN is a serious cause for renal scarring in our patients, particularly if associated with other risk factors such as recurrent infections and the female sex.

Randomised trial of oral versus sequential intravenous/oral cephalosporins in children with pyelonephritis

“…The proportions of renal scarring in patients (oral group: 26%; intravenous/oral group: 46%) were comparable with previous scintigraphy investigations that documented renal scarring in 29-60% of children after acute pyelonephritis [5,15,16,21,24,30,31,35]. These results indicate that mere oral ceftibuten therapy is as efficacious as parenteral therapy, i.e.…”

“…In the study by Montini et al [21], amoxicillin/clavulanic acid was given for 10 days to 135 children aged 1 month to 7 years. Renal scarring developed in 26/96 patients (28%), with lesions on acutephase scintigraphy comparable to the 26% found among children with oral treatment in our study and in earlier studies [5,15,16,24,30,35]. However, the high prevalence of resistance of common urinary pathogens against amoxicillin/clavulanic acid in our unit (>30% of E. coli isolates are resistant against amoxicillin/clavulanic acid) and many other centres precludes the empiric use of this antimicrobial [27].…”

“…Up to two thirds of children with acute pyelonephritis show a lesion (defect) on technetium99m-labelled dimercaptosuccinic acid (DMSA) scintigraphy during the acute phase [5,14,21,25]. Only these children develop post-infectious renal scarring and the incidence is 29-60% [5,15,21,24,30,35]. Long-term follow-up of children with renal scarring showed a significant reduction of renal function [20,32,33].…”

Comparison of planar DMSA scan with an evaluation based on SPECT imaging in the split renal function assessment

“…Renal cortical scintigraphy using Dimercaptosuccinic Acid labeled by Technetium-99m ( 99m Tc-DMSA) is widely used in pediatric nephro-urology practice [1][2][3][4][5][6][7][8][9][10][11][12]. Under usual conditions the renal parenchyma is visualized without interference from the pelvicalyceal system and good images and a good estimation of the function can be obtained [1].…”

Prevalência de pielonefrite aguda e incidência de cicatriz renal em crianças menores de dois anos de idade com infecção do trato urinário avaliadas por cintilografia renal com 99mTc-DMSA: a experiência de um hospital universitário

“…Besides late diagnosis (with associated late therapeutics), age under one year, presence of vesicoureteral reflux (VUR) particularly with high degree, presence of obstructive lesions and occurrence of recurrent APNs, constitute factors associated with the development of permanent renal damage (1,6) . Renal cortical scintigraphy with technetium-99m labeled dimercaptosuccinic acid ( 99m Tc-DMSA) is known as the most sensitive method for detecting renal parenchymal lesions, either caused by APN or by scarring (7) . It is a noninvasive method and is highly sensitive and specific for detecting of renal inflammation and formation of scarring, allowing to assess the progression of renal damage and functional loss since the initial episode(APN) (6) .…”