RENAL CORTICAL SCINTIGRAPHY IN THE ASSESSMENT OF ACUTE PYELONEPHRITIS IN CHILDREN

Abstract

Acute pyelonephritis is a major cause of morbidity in children with urinary tract infection and can result in irreversible renal scarring leading to hypertension and end-staged renal disease. Tc-99m-dimercaptosuccinic acid (DMSA) scintigraphy is the imaging modality of choice for the detection of acute pyelonephritis and renal scarring. Forty-nine children (ages ranging from 9 months to 11 years) with urinary tract infection, having positive urine culture, were studied. A DMSA scan was performed within 72 hours of receiving antibiotic during acute infection. Follow-up scintigraphy was done at 6 months of initial scan in children with acute pyelonephritis documented by DMSA scan. Scintigraphy showed changes consistent with acute pyelonephritis in 27 (55.10%) children and the abnormalities were bilateral in 17 (63%) cases and unilateral in 10(37%) cases. Among these 44 abnormal kidneys, scintigraphy demonstrated solitary defect in 29 kidneys, multiple defects in 6 kidneys and diffused decreased uptake in 9 kidneys. Twenty children (34 kidneys) were available for follow-up evaluation and scintigraphy showed complete recovery in 21 of 34 (62%) kidneys and renal scarring in 13 of 34 (38%) kidneys. Renal scarring was found in 5 of 7 kidneys (71%) with diffuse decreased uptake, 2 of 5 kidneys (40%) with multiple cortical defect and 6 of 22 (27%) with single focal defect. From the study, it is observed that the scintigraphic pattern of acute pyelonephritis might be helpful to JAN. - APR. 2006 Volume XII Number| assess the risk of renal damage due to scarring following acute pyelonephritis.