role of DMSA scan in detection of renal cortical scaring in children with urinary tract infection

ABSTRACT

Urinary tract infection [UTI] is one of the most common bacterial diseases in children, it may cause renal scars, which can lead to hypertension and renal failure. Diagnostic imaging is therefore important to detect children with scaring. Dimercaptosuccinic Acid [DMSA] is clearly more sensitive than routine renal ultrasonography or even intravenous urography for detecting renal scaring, but newer high-resolution ultrasonography is almost as sensitive as DMSA in diagnosing acute renal involvement A total number of 100 children with UTI were included in this study, their ages ranged from 2 to 12 years [35 boys, 65 girls]. They were selected from nephrology clinic and out patient clinic of pediatrics department of EL-Minia University hospital. They were divided into 2 groups depending on their ages Group I It included 44 patients, their ages ranged from 2 to 6 years, Group II It included 56 patients, their ages ranged from [6-12 years], The patients were selected depending up on the presence of suggestive symptoms and signs of upper and lower UTI and positive urine culture. All patients were subjected to a thorough history taking, full clinical examination and laboratory investigations [urine analysis, urine culture, kidney function, ASOT, C-reactive protein and blood picture]. Radiologic investigation in the form of abdominal ultrasonography and DMSA scanning were done. The present study revealed that the total incidence of renal cortical scarring and diffuse photon defect [unilateral and bilateral] was 9% and 27% respectively for all patients with urinary tract infection i.e. abnormal DMSA scintigraphy represent 36%. Furthermore, there were significantly more children with abnormal DMSA and DMSA scarring among those who had upper urinary tract infection compared with those with lower urinary tract infection. DMSA scan is more reliable method than ultrasonography in detection of renal cortical scaring in cases of UTI. The clinician should be free to recommend a DMSA scan in a child with a history suggestive of acute pyelonephritis, or in cases of frequent recurrences of UTI