DMSA study performed during febrile urinary tract infection: a predictor of patient outcome?

Abstract

Technetium-99m dimercaptosuccinic acid (DMSA) study has been advocated as a method for the assessment of renal sequelae after acute febrile urinary tract infection (UTI). However, it is not known whether DMSA scintigraphy performed during acute UTI has any prognostic value for outcome assessment. The objective of this study was to evaluate the usefulness of DMSA scintigraphy performed during UTI as a predictor of patient outcome, to identify children at risk of events [vesico-ureteral reflux (VUR) or recurrent UTI] that may lead to the development of progressive renal damage. One hundred and fifty-two children (including 78 girls) with a mean age of 20 months (range 1 month to 12 years) with first febrile UTI were evaluated by DMSA scintigraphy during acute UTI. After acute UTI, children were explored by voiding cysto-urethrography. Children who presented an abnormal DMSA study, or a normal DMSA study but VUR or recurrent UTI, underwent a DMSA control study 6 months after UTI. Children with VUR were followed up by direct radionuclide cystography. DMSA scintigraphy performed during acute UTI was normal in 112 children (74%). In 95 of these children, follow-up DMSA scintigraphy was not performed owing to a good clinical outcome. In the remaining 17 children, follow-up scintigraphy was normal. Forty children (26%) presented abnormal DMSA study during acute UTI. Twenty-five of them presented a normal follow-up DMSA, and 15 presented cortical lesions. Children with abnormal DMSA had a higher frequency of VUR than children with normal DMSA (48% vs 12%). It is concluded that children with normal DMSA during acute UTI have a low risk of renal damage. Children with normal follow-up DMSA and low-grade VUR have more frequent spontaneous resolution of VUR.

Risk factors of renal scars in children with acute pyelonephritis

“…[17][18][19] They demonstrated the efficiency of this imaging modality for clinical use in comparison with conventional imaging techniques such as ultrasound, CT and MRI methodology. Comparatively, ultrasound has not a high sensitivity for APN and spiral CT and MRI, with equal sensitivity, are not routinely recommended.…”

Diagnóstico de reflujo vesicoureteral según las guías de 1999 y de 2011 del Subcomité de Infección Urinaria de la Academia Americana de Pediatría

“…Sin embargo, dado que habitualmente recibimos a la mayoría de los pacientes con ITU del Hospital para completar su estudio y que excluimos a los pacientes con uropatías conocidas, la distribución de los grados de RVU fue similar a la observada por otros autores. 35 Por otro lado, el hecho de que ningún paciente del grupo evaluado luego de la aparición de las guías de 2011 se haya estudiado por ITU atípica tal vez refleje un inadecuado reconocimiento de esta, lo que retrasa su referencia para estudio.…”

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

“…cases of febrile UTI and high-degree VUR. On the other hand, the incidence of renal scarring ranges from 15% to 62% (9)(10)(11)(12)(13) . In the present review, the authors' have not found in the Brazilian literature any study aimed at determining the prevalence of APN and incidence of renal scarring in the pediatric population.…”

“…For occurrence of APN, for example, some studies report a frequency of 26% (9) , while others report 57% prevalence of renal infection in the investigated population (10) . Most studies utilize renal scintigraphy with DMSA for the diagnosis of such conditions.…”