The evaluation of acute pyelonephritis and renal scarring with technetium 99m-dimercaptosuccinic acid renal scintigraphy: evolving concepts and future directions

Hg, Rushton

doi:10.1007/s004670050243

Cited by 249 publications

(182 citation statements)

References 96 publications

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“…Establishing the diagnosis of acute pyelonephritis (APN) requires imaging with 99m Tc-dimercaptosuccinic acid (DMSA) scintigraphy to view renal parenchymal involvement (3). Although a DMSA scan is considered to be very sensitive in the assessment of renal damage, it is expensive, not readily available in all centers, and exposes the patients to radiation (4). Therefore, a more practical and accessible tool to determine the presence of renal parenchymal involvement could be helpful for the timely management of UTIs.…”

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Plasma neutrophil gelatinase-associated lipocalin predicts acute pyelonephritis in children with urinary tract infections

et al. 2015

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Background:The identification of acute pyelonephritis (APN) is still a challenge. Methods: Patients admitted for their first urinary tract infection (UTI) were enrolled. Plasma neutrophil gelatinaseassociated lipocalin (NGAL) levels were measured at admittance and after treatment. Laboratory, clinical, and imaging results were compared between children with and without APN. results: A total of 123 patients were enrolled (53 APN and 70 lower UTI). After adjusting for age and gender, plasma NGAL levels were higher in the APN group than in the lower UTI group (233 (129-496) ng/ml vs. 71 (50.8-110) ng/ml, P < 0.001). NGAL levels were correlated with the serum levels of leukocytes, C-reactive protein, and creatinine, as well as fever duration (P < 0.05). Multivariable analysis revealed that logtransformed plasma NGAL was an independent predictor of APN (P < 0.05). Receiver operating curve analysis showed a good diagnostic profile of NGAL for identifying APN (area under the curve 0.864) with a best cut-off value of 102.5 ng/ml. The NGAL levels in both two groups decreased after treatment compared to levels before treatment (P < 0.001). conclusion: Plasma NGAL can be a sensitive predictor for identifying APN and monitoring the treatment response of pediatric UTI. u rinary tract infections (UTIs) are among the most common bacterial infections in children (1). Early detection and proper management of UTIs is important since UTIs involving the kidney may cause permanent renal scarring and be a risk factor for future development of renal insufficiency (2). Establishing the diagnosis of acute pyelonephritis (APN) requires imaging with 99m Tc-dimercaptosuccinic acid (DMSA) scintigraphy to view renal parenchymal involvement (3). Although a DMSA scan is considered to be very sensitive in the assessment of renal damage, it is expensive, not readily available in all centers, and exposes the patients to radiation (4). Therefore, a more practical and accessible tool to determine the presence of renal parenchymal involvement could be helpful for the timely management of UTIs.Neutrophil gelatinase-associated lipocalin (NGAL), as a member of the lipocalin superfamily, is produced from the nephron in response to tubular epithelial damage (5). It has been identified as one of the earliest and potentially one of the most indicative biomarkers of acute kidney injury (AKI) from a diverse array of conditions and can differentiate between prerenal and intrinsic causes (6,7). Urinary NGAL (uNGAL) levels increase in patients with different causes of nephropathies (8,9) and might be a valuable tool in monitoring the treatment response of various renal diseases (10,11).As an iron-carrier protein derived from human neutrophils, NGAL also plays an important role in the innate immune response to bacterial infection (12). Experimentally, NGAL was capable of blocking Escherichia coli growth under ironpoor conditions, but NGAL with siderophore iron was not (13). NGAL-knockout mice demonstrated substantially increased mortality after intraperitoneal i...

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Plasma neutrophil gelatinase-associated lipocalin predicts acute pyelonephritis in children with urinary tract infections

et al. 2015

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“…Prompt diagnosis of the infection and the localization of its level are of great importance in determining the duration of treatment and the appropriate investigation. In the last decade, the dimercaptosuccinic acid (DMSA) scintigraphy has been considered an objective method for the localization of the UTI site, [1][2][3] although there are some concerns about its accuracy in infancy. 4 The clinical parameters and inflammatory markers, which primarily have been used as indices for the differentiation of lower from upper UTI, are fever, age, reflux, leukocytes and/or neutrophil count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), N-acetyl-␤-glucosaminidase (NAG), and b 2 microglobulin.…”

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Polymorphonuclear Elastase as a Diagnostic Marker of Acute Pyelonephritis in Children

Fretzayas¹,

Moustaki²,

Gourgiotis³

et al. 2000

Pediatrics

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ABSTRACT. Objective. Experimental evidence suggests that neutrophils and their metabolites play an important role in the pathogenesis of pyelonephritis. The aim of this study was to investigate the diagnostic value of polymorphonuclear elastase-a 1 -antitrypsin complex (E-a 1 -Pi) for the detection of acute pyelonephritis in children.Methods. Eighty-three patients, 29 boys and 54 girls, 25 days to 14 years of age, with first-time symptomatic urinary tract infection were prospectively studied. Fiftyseven healthy children served as controls. Dimercaptosuccinic acid (DMSA) scan and voiding cystourethrography were performed in all patients. Plasma and urinary E-a 1 -Pi, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), neutrophil count, urinary N-acetyl-␤-glucosaminidase (NAG), N-acetyl-␤-glucosaminidase b (NAG b), and creatinine levels were measured in all patients on admission and 3 days after the introduction of antibiotics. The same markers were also measured in the control subjects.Results. Planar DMSA scintigraphy demonstrated changes of acute pyelonephritis in 30 of 83 children (group A). It was normal in the remaining 53 children (group B). The sex and age distributions were not significantly different between the 2 groups, as well as between the patients and the control subjects (group C). Nineteen of the 53 children with a normal DMSA had body temperature >38°C, whereas all but 4 children with abnormal DMSA had temperature >38°C. Therefore, the temperature was significantly different between these 2 groups. The sensitivity and specificity of fever (>38°C) as an indicator of renal involvement based on isotopic findings were 86% and 64%, respectively. Given the significant number of the febrile children with normal DMSA scintiscans, group B was subdivided into B 1 with 19 febrile children (14 boys and 5 girls) and B 2 with 34 children whose body temperature was below 38°C (8 boys and 26 girls). The sex and age distribution was significantly different between groups B 1 and B 2 . The mean age of group B 1 was .78 years (range: 28 days to 9 years; median: .25 years; standard deviation: 2.1). All but 1 child in this group were younger than 1 year of age. In contrast, in group B 2 , there were only 4 infants, the remaining 30 children were older than 2.5 years (mean age: 6 years; median: 7 years; standard deviation: 3.5; range: 34 days to 12 years). The mean duration of fever before hospital admission was 2.8 days for group A and 1.8 days for group B 1 . This difference was not statistically significant. Similarly, body temperature was not significantly different between these 2 groups. The distribution of plasma E-a 1 -Pi values was normal in the control subjects. The sensitivity and specificity of plasma E-a 1 -Pi, as an indicator of renal involvement, were 96% and 50%, respectively, taking the 95th percentile of the reference range as a cutoff value. However, considering as a cutoff value the level of 72 g/dL (95th percentile of group B 2 ), its sensitivity and specificity were 74% and 86%, resp...

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“…A hipocaptação focal com preservação do contorno renal associado à queda na captação relativa do radiofárma-co pelo rim acometido foi a alteração mais freqüente no exame com DMSA em crianças portadoras de PNA. Estes resultados estão de acordo com os descritos por Rushton 12 .…”

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“…A presença de hipocaptação renal do DMSA acompanhada de deformidade é sugestiva de cicatriz pielonefrítica pregressa. Não pudemos afastar, contudo, a possibilidade de novo foco de PNA próximo à área cicatricial, pois, em rins previamente lesados, a área circunvizinha à fibrose torna-se mais suscetível ao refluxo intra-renal, aumentando a extensão da lesão 12,29 . Desse modo, mesmo que, em pequeno número de casos, ocorra resultado falso positivo na cintilografia renal com DMSA, na dúvida em se tratar de processo puramente cicatricial pregresso ou novo foco infeccioso adjacente à cicatriz pré-estabelecida, a terapêutica para PNA está justificada.…”

Section: Discussionunclassified

“…A captação do DMSA reflete a integridade funcional do parênquima renal, principalmente no que se refere a córtex.Na PNA, a concentração do DMSA pode estar afetada por alteração no fluxo intra-renal ou na reabsorção tubular proximal 12 . Durante o processo de pielonefrite aguda encontramos hipocaptação do radioisótopo de forma focal ou difusa, uni ou bilateral, que poderá ser acompanhada de aumento do volume renal, como é observado na USG, ou atenuação do contorno renal sem, contudo, apresentar deformidade.…”

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Cintilografia renal com ácido dimercaptossuccínico marcado com tecnécio no diagnóstico da pielonefrite na infância: estudo de 17 casos

Guidoni¹,

Maroni²,

Mimica³

et al. 2001

J. Pediatr. (Rio J.)

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ResumoObjetivo: a infecção do trato urinário é uma das doenças bacterianas mais freqüentes em pediatria. O envolvimento infeccioso renal (pielonefrite) pode evoluir com formação de cicatriz renal irreversível com conseqüente perda funcional e dano renal progressivo. Estudos recentes sugerem que até 50-60% das cicatrizes renais poderiam ser evitadas ou atenuadas com o diagnóstico precoce da pielonefrite. O objetivo deste estudo é determinar se a presença de alterações na cintilografia renal com DMSA na fase aguda da infecção urinária pode ser indicadora de pielonefrite.Métodos: empregamos a técnica de washout em 17 meninas portadoras de infecção urinária como padrão-ouro na localização do sítio da infecção. Todas as crianças realizaram cintilografia renal com DMSA na fase aguda da infecção. Os resultados foram analisados pelo teste do qui-quadrado ou de Fisher.Resultados: a cintilografia renal com DMSA detectou alterações em todos os cinco casos de pielonefrite diagnosticados pelo washout sugerindo envolvimento renal. Observamos também que apenas uma das crianças com cistite (total = 12 casos) apresentava alterações ao DMSA. Portanto, a sensibilidade e especificidade deste estudo com DMSA na fase aguda da infecção foi de 100% e 92% respectivamente no diagnóstico da pielonefrite.Conclusões: a cintilografia renal com DMSA mostrou-se méto-do sensível no diagnóstico da pielonefrite aguda em crianças. AbstractObjective: to determine whether the presence of abnormal results in DMSA renal scintigraphy indicates pyelonephritis.Methods: we performed the washout test in 17 children with urinary tract infection, as a criterion standard, to locate the infection site. All the children underwent DMSA renal scintigraphy in the acute phase of the disease. The results were analyzed by the chisquare test or Fisher test.Results: DMSA renal scintigraphy revealed changes in all five cases of pyelonephritis, suggesting acute kidney involvement. On the other hand, only one child with cystitis (total = 12 cases) had abnormal results in renal scintigraphy. Sensitivity and specificity were 100% and 92%, respectively.Conclusion: DMSA renal scintigraphy is a sensitive method for the diagnosis of pyelonephritis in children. Introdução Definem-se três tipos de ITU de acordo com sua localização e repercussão no trato urinário: bacteriúria assintomática, cistite e pielonefrite aguda (PNA). A bacteriúria assintomática e a cistite são infecções benignas, pois não acarretam prejuízo à função renal. A pielonefrite, porém, é particularmente importante, podendo acarretar danos renais progressivos e irreversíveis 1-3 . J Pediatr (RioOs parâmetros clínicos de localização da ITU (cistite ou pielonefrite) são, em geral, pouco específicos e de difícil

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The evaluation of acute pyelonephritis and renal scarring with technetium 99m-dimercaptosuccinic acid renal scintigraphy: evolving concepts and future directions

Cited by 249 publications

References 96 publications

Plasma neutrophil gelatinase-associated lipocalin predicts acute pyelonephritis in children with urinary tract infections

Plasma neutrophil gelatinase-associated lipocalin predicts acute pyelonephritis in children with urinary tract infections

Polymorphonuclear Elastase as a Diagnostic Marker of Acute Pyelonephritis in Children

Cintilografia renal com ácido dimercaptossuccínico marcado com tecnécio no diagnóstico da pielonefrite na infância: estudo de 17 casos

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