engleski

First Upper Urinary Tract Infection In Children – Is 99mTc-DMSA Scintigraphy Pathological?

During the last year, we performed 522 99mTc-DMSA examinations in children with different kidney diseases and in these material we evaluate only DMSA scans in children after first upper acute urinary tract infections (UTI) to find out the incidence of the first pathological changes. After first UTI we examined 107 children, (70 girls and 37 boys, aged from 1 month to 16 years). Scintigraphy was performed between 2 weeks after the beginning of UTI and, most of them, inside 6 months of infection. Children had renal ultrasound examination (US) and they underwent voiding cystourethrography where in 64 children vesicoureteral reflux (VUR) was detected. DMSA scans were graded as normal, pathologic or equivocal and compared with US findings and with different VUR degree. In total of 211 kidney units (83 without and 128 with VUR), pathological DMSA scan were found in 30 kidneys (14, 2%). 15 defects were in kidneys without (83) and 15 in kidneys with (128) VUR (p = n.s.). Equivocal findings on DMSA scans were detected in 69 kidneys (32, 7%) ; 24 kidneys without and 45 in kidneys with different degree of refluks (p = n.s.). Normal DMSA scans were found in 112 kidneys (53, 1%), in 43 without and in 69 with VUR (p = n.s.). US exam detected dilatation in 18, 6% kidneys without and in 33, 02% kidneys with VUR. We do not find diferences in pathologic and equivocal DMSA findings between kidneys with or without VUR. The reasons for these we can find in wide range of investigation period according the time from the beginning of infection and in the knowledge that not only VUR is associated with a high risk of scarring. In children with UTI prompt initiation of antibiotic treatment is very important for the prevention of renal damage.

first upper urinary tract infection DMSA scintigraphy

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