Febrile urinary tract infection in children: role of 99m TC-dimercaptosuccinic acid [DMSA] scan and other imaging techniques

ABSTRACT

Fifty children [37 females and 13 males] with first febrile urinary tract infections were studied to assess the value of 99M Tc-dimercaptosuccinic acid [DMSA] scan in detecting inflammatory changes of acute pyelonephritis [APN]. These findings were compared with renal ultrasonography [US]. We also evaluated the reliability of clinical and laboratory observations in diagnosing acute pyelonephritis [APN]. All children had micturating cystourethrography [MCUG]. DMSA-documented acute pyelonephritis was present in 29 [58%] patients. Only four children [8%] demonstrated changes suggestive of APN on renal ultrasonography. Vesicoureteric reflux [VUR] was documented in 17 [47%] of the total group and in 13 [45%] of those with abnormal DMSA scan. Follow-up DMSA scan in 15 children with initial abnormal findings showed complete recovery in seven [47%]. Our data have shown that DMSA renal scan is the most useful investigational procedure in children with febrile UTI. The diagnosis of APN, depending on clinical and laboratory data, is unreliable. Renal US alone can miss serious renal defects. MCUG remains the most sensitive procedure to detect VUR and it should be performed in all children with UTI and abnormal DMSA scan. Early detection of acute pyelonephritis allows the prompt introduction of antimicrobial agents in those children and can prevent or decrease renal damage and its complications