Renal imaging with 99Tcm-labelled DMSA in the detection of acute pyelonephritis

Parkhouse, Helen; Godley, Margaret L.; Cooper, John N.; Risdon, R. A.; Ransley, P. G.

doi:10.1097/00006231-198901000-00010

Cited by 76 publications

(21 citation statements)

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“…Recently 99mTc DMSA scan has been introduced as a new investigation tool in the study of the renal parenchyma during UTI [2,4,10,14,15,16,17]. Experimental studies in rats and pigs have shown a good correlation between induced pyelonephritis and abnormal findings on 99mTc DMSA scan [11,12,18]. In children a decreased retention of 99mTc DMSA by the renal parenchyma was described during the acute phase of UTI in 30%-54% of cases [6,10,14,16,17].…”

Section: Discussionmentioning

confidence: 99%

Involvement of the renal parenchyma in acute urinary tract infection: The contribution of99mTc dimercaptosuccinic acid scan

et al. 1992

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We performed 99mTc dimercaptosuccinic acid (DMSA) scan and ultrasonography in 146 children during the acute phase of a proven urinary tract infection (UTI). In 99 a micturating cysto-urethrography and in 83 an intravenous urography was also done. The occurrence of fever and increased WBC count, CRP and ESR were also studied. It appeared from this retrospective study that 47% of the kidneys had a cortical or patchy pattern of decreased uptake of 99mTc DMSA, as compared to 23% with abnormal findings on US. Vesico-ureteral reflux was present in 38% of the kidneys with parenchymal involvement on 99mTc DMSA scan. Although fever, leucocytosis and elevated CRP and ESR were significantly correlated with abnormal 99mTc DMSA scan, they were also observed in children without renal parenchymal involvement. Our results suggest that 99mTc DMSA scan is a sensitive method for the detection of parenchymal involvement during acute UTI. The exact nature of these lesions and their relation with scars need, however, to be defined.

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Section: Discussionmentioning

confidence: 99%

Involvement of the renal parenchyma in acute urinary tract infection: The contribution of99mTc dimercaptosuccinic acid scan

et al. 1992

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“…Because the clinical symptoms are nonspecific, the diagnosis of renal infection needs to be supported by laboratory data and radiologic imaging. Renal cortical scintigraphy with technetium-99 m -labeled dimercaptosuccinic acid (DMSA), although not perfect, appears to be the best clinically applicable standard of reference for the diagnosis of acute pyelonephritis [3,4,5]. It is considered the most sensitive technique for the identification of the renal parenchymal change in acute pyelonephritis (APN), as well as in the detection of scarring.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of acute pyelonephritis with DMSA scans in children presenting after the age of 5 years

et al. 2005

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It is generally believed that infants are more susceptible to development of renal scarring after pyelonephritis than children over 5 years old. This view has led to differences in investigations and treatment according to age. The aim of this prospective study was to assess the occurrence of renal parenchymal lesion in children over 5 years admitted with a first-time symptomatic urinary tract infection (UTI). Between October 2000 and April 2002, 52 children aged over 5 years who were admitted to our department with probable acute pyelonephritis (APN) and a positive urine culture were included in this study. All children received antibiotics for 14 days. During the acute phase of infection, scintigraphy with technetium-99m-labeled dimercaptosuccinic acid (DMSA) and ultrasonography (US) were done. Voiding cystourethrography (VCUG) was performed in all children early in the course of the illness, generally within 5-7 days of hospitalization. When scintigraphy showed renal parenchymal changes, repeat scintigraphy was done after at least 3 months to assess the progression of renal abnormalities. Of the 52 children with a first-time documented pyelonephritis, cortical scintigraphy showed renal lesion in 41 children (78.8%). US was normal in all children with normal renal scintigraphy, while it detected renal abnormalities in 16 of the 41 (39 %) with abnormal scintigraphy (p <0.0001). Topographic analysis of the 165 focal lesions showed that 42.4% were localized to the upper poles, 17.5% to the middle third, and 40% to the lower poles of the kidneys. Repeat scintigraphy showed persistent lesions corresponding to those on the initial scan in nine (28.2%) of the 32 children. Renal lesions had partly regressed in 23 (71.8%) of the patients who underwent repeat scintigraphy. Vesicoureteral reflux was observed in 13.4% of kidneys and renal parenchymal abnormalities were identified in 71.4% and 72.2% of renal units, respectively, with and without reflux ( p >0.05). In conclusion, our data did not confirm the conventional opinion that the risk of renal scarring after pyelonephritis is low in children over the age of 5 years. Our findings suggest that renal scintigraphy may be a more appropriate method of investigation than VCUG for evaluation of the children over 5 years with acute pyelonephritis. Additionally, the frequency of scintigraphic changes is high, and a strategy based exclusively on ultrasound findings would miss about 61% of the abnormal renal units. We recommend that all children, irrespective of age, will benefit from further investigations that might prevent or limit the development of scarring process and renal complications.

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“…Experimental studies in piglets, which have a multipapillary renal architecture similar to humans, demonstrated that DMSA scan has a sensitivity of 80%-91% and a specificity of 99%-100% for detecting acute pyelonephritic lesions [19,20,21]. When the severity of pyelonephritis was graded according to the extent of renal parenchymal involvement, the undetected lesions were minimal [21].…”

Section: Discussionmentioning

confidence: 99%

Resistive index in febrile urinary tract infections: predictive value of renal outcome

Özçelik¹,

Polat

Aktas

et al. 2004

Pediatric Nephrology

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In the absence of specific symptomatology in children, the early diagnosis of acute pyelonephritis is a challenge, particularly during infancy. In an attempt to differentiate acute pyelonephritis from lower urinary tract infection (UTI), we measured intrarenal resistive index (RI). We evaluated its ability to predict renal involvement as assessed by dimercaptosuccinic acid (DMSA) scintigraphy. In total 157 patients admitted to the pediatric department of the Sişli Etfal Hospital with clinical signs of febrile UTI were included in the study. The children were divided into groups according to their age at the time of ultrasonography (US). RI was measured from the renal arteries with Doppler US in the first 72 h in all 157 children. Renal involvement was assessed by (99m)Tc-DMSA scintigraphy in the first 7 days after admission. The examination was repeated at least 6 months later if the first result was abnormal. All available patients with an abnormal scintigraphy underwent voiding cystourethrography 4-6 weeks after the acute infection. All patients with vesicoureteral reflux and scarred kidneys were excluded from the study. DMSA scintigraphy demonstrated abnormal changes in 114 of 157 children and was normal in the remaining 43 children. Of these 114 children, 104 underwent repeat scintigraphy, of whom 77 showed partially or totally reversible lesion(s). Of these 77 children, 17 children (22%) with vesicoureteral reflux were excluded. Thus, we compared the 43 children with lower UTI with the 60 children with definite acute pyelonephritis at admission. Kidneys with changes of acute pyelonephritis had a mean RI of 0.744+/-0.06 in infants, 0.745+/-0.03 in preschool children, and 0.733+/-0.09 in patients of school age with upper UTI. However, the mean RI was 0.703+/-0.06 in infants, 0.696+/-0.1 in preschool children, and 0.671+/-0.09 in school-aged patients with lower UTI. The mean RI values were significantly higher in patients with upper UTI ( P<0.001). There was a highly significant correlation between RI values and the severity of the renal lesion as ranked by DMSA scintigraphy ( P<0.001). When the cut-off RI value was 0.715, there was an 80% sensitivity and a 89% specificity for diagnosing upper UTI. Refluxing kidneys and scarred kidneys also had higher RI values. In conclusion, RI values were increased significantly in children with febrile UTI when renal parenchymal involvement (assessed by DMSA scintigraphy) was present. Our results also support the view that the children with high RI values are at a high risk of reflux, scarring, or both, which was frequently observed in febrile UTI. This might allow identification of patients at risk for severe renal lesions that require more aggressive therapy, investigation, and follow-up than those with lower UTI.

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Renal imaging with 99Tcm-labelled DMSA in the detection of acute pyelonephritis

Cited by 76 publications

References 0 publications

Involvement of the renal parenchyma in acute urinary tract infection: The contribution of99mTc dimercaptosuccinic acid scan

Involvement of the renal parenchyma in acute urinary tract infection: The contribution of99mTc dimercaptosuccinic acid scan

Evaluation of acute pyelonephritis with DMSA scans in children presenting after the age of 5 years

Resistive index in febrile urinary tract infections: predictive value of renal outcome

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