Abnormal Dimercaptosuccinic Acid Scan May Be Related to Persistence of Vesicoureteral Reflux in Children with Febrile Urinary Tract Infection

Abstract

PurposeThis study assessed whether 99mtechnetium dimercaptosuccinic acid (DMSA) scintigraphy used for the assessment of renal sequelae after febrile urinary tract infection (UTI) has any prognostic value for outcome measurement of vesicoureteral reflux (VUR) by retrospectively evaluating the correlation between abnormal DMSA scintigraphy results and persistence of VUR in children with febrile UTI.Materials and MethodsThe medical records of 142 children (57 boys, 85 girls) admitted with febrile UTI from January 2004 to December 2006 and who were followed up for more than 1 year were retrospectively reviewed. At the initial and follow-up visits, renal ultrasound and DMSA scans were performed within 7 days from the diagnosis and voiding cystourethrography (VCUG) was performed within 1 month in all case and follow-up evaluations.ResultsThe children's mean age was 4.8±3.6 years (range, 0.3 to 14 years). The mean follow-up was 28.2±4.8 months. At the initial examination, VUR was more often associated with an abnormal DMSA scan result (83.3%) than with a normal DMSA scan result (16.7%, p=0.02). The frequency of VUR with an abnormal DMSA scan during acute UTI was significantly higher than the frequency of VUR with a normal DMSA scan (38.8% vs, 25.8%, respectively, p=0.004). Also, high-grade VUR was associated with an abnormal DMSA scan result (32.5%) more often than with a normal DMSA scan result (0%, p=0.01). Children with an abnormal DMSA scan had a lower resolution rate of VUR (17.5%) than did children with a normal DMSA scan (75.0%) at the follow-up VCUG (p=0.02).ConclusionsAn abnormal result on a DMSA scan during febrile UTI is associated with high-grade and persistent VUR. DMSA scans performed during febrile UTI are useful in reflux resolution in childhood.

Early dimercaptosuccinic acid renal scan in children with first febrile urinary tract infection

“…High sensitivity and high negative predictive value of early DMSA renal scan for VUR, as seen in this study has also been observed in some other studies [8][9][10]. Though contradicting results are observed in some studies [5,10], it has been observed that in children with dilating VUR missed out by early DMSA, development of significant renal disease was uncommon [3,12,13]. Some guidelines recommend detailed evaluation only after the second episode of febrile UTI but this may not be ideal in our population due to higher proportion of children having VUR and uncertainty in follow up.…”

Are DMSA Scans Reliable for Diagnosing Vesicoureteral Reflux in Infants and Children?

“…In recent study by Hyun Chong Ki "The incidence of VUR with a normal DMSA scan result was very low, and the degree of VUR in those children was low-grade and clinically insignificant." [27] and another study by Tseng et al said that "142 children with VUR and reported that all the children with grades III to V VUR (21 patients) had an abnormal DMSA scan result" [28]. These studies are agreed with the present study, most children with normal DMSA scan finding had low grade reflux.…”

“…In this study, 48 of 65 children (74%) the DMSA scintigraphy shows abnormal findings during the period of UTI while the VCUG scan study shows VUR in 75% of the children during the period of UTI. The DMSA scan study results agree with Hyun Chong Ki, in his study "abnormal DMSA scintigraphy results were found in 72.5% of children with febrile UTI" [27] but the high frequency of VCUG scan study doesn't agree with his study that have reported "VUR was found in 33.8% of the children with acute febrile UTI" [27].…”

Dimercaptosuccinic Acid Scan as an Alternative Diagnostic Approach in Vesicoureteric Reflux Disease

“…Vesicourethral reflux (VUR) is defiened as retrograde passage of urine from the bladder into kidney and upper urinary tract (1,2). This condition can increase transporting bacteria from the bladder to the kidney and then predisposes patients to acute pyelonephritis (3,4).…”