The Detection of Reflux Nephropathy in Infants by ^99m technetium Dimercaptosuccinic Acid Studies

Abstract

Dimercaptosuccinic acid (DMSA) studies were performed in 113 infants less than 1 year old at risk of renal scarring. Of these patients 86 presented with urinary tract infection and 27 were asymptomatic. A voiding cystourethrogram was performed in all cases and excretory urography (IVP) was done in 99. More abnormalities were detected by DMSA study when compared to scars on IVP. When both studies were abnormal there was an excellent correlation on a site by site basis. Fever or systemic disorder was not a reliable sign to determine whether there was upper tract involvement with infection. The incidence of DMSA abnormalities in infants increased with high grade vesicoureteral reflux and decreased with low grade reflux. There was no significant difference in the incidence of abnormal kidneys between the infected and noninfected groups, suggesting that renal scarring may occur with sterile reflux.

Clinical effectiveness and cost-effectiveness of tests for the diagnosis and investigation of urinary tract infection in children: a systematic review and economic model

“…Seven studies evaluated 99m Tc-DMSA, 133,138,141,193,196,214,217 and one study evaluated 123 I-hippuran. 218 Half of these studies did not include an appropriate spectrum of patients.…”

Frequency of Hypertension with Ambulatory Blood Pressure Monitoring in Children with Renal Damage

“…Different subtypes of renal damage are described in reflux nephropathy (17) . Focal cortical scarring, either as a single scar or multiple confluent lesions, usually occurs in the upper or lower pole, and often considered to be the result of pyelonephritic episodes.…”

Incidence of Post-Ureteric Reimplantation Urinary Tract Infection in Primary Vesicoureteral Reflux

“…In both these studies scarring was detected by IVP studies. DMSA scan is the most sensitive tool for detecting renal scars [15,16]. Renal deterioration on DMSA scan is defined as a decrease in differential function of greater than 3% in a renal unit [17].…”