The valuation of Tc-99m DMSA renal cortical scintigraphy for prediction of renal scarring in Chinese children with acute pyelonephritis

Abstract

1196

Objectives: To determine the incidence of renal scarring in a group of children with acute pyelonephritis (APN) firstly and to evaluate relative factors at risk of scarring using Tc-99m DMSA renal cortical scintigraphy.

Methods: One hundred and eighteen patients (44 males , 74 females, age range, 1m~14y) with APN underwent DMSA renal scan before treatment and six month after treatment to identify renal damage and renal scarring. The degree of renal damage was divided to grade 1 to 4. A directed radionuclide cystography (DRC) was performed in 72 cases to evaluate vesicoureteric reflux (VUR).

Results: The follow-up renal scan revealed that 79 normal kidneys on first scan remained normal; of 64 kidneys with grade 1 damage, 7.81% developed renal scar; of 51 kidneys with grade 2, 49.02% developed renal scar; of 19 with grade 3, 68.42% developed renal scar; of 23 with grade 4, 100% developed renal scar. There was a significant relationship between the incidence of renal scar on follow-up and the grade of renal damage on first scan (r=0.877, P<0.01). The higher grade of renal damage on first DMSA scan, the more renal scar caused. There was a significant relationship between the degree of scarring in follow-up and the grade of VUR (r=0.624, P<0.01).

Conclusions: There are the important clinical valuations for prognosing the risk of renal scarring by using the acute DMSA renal scan in children with APN. Quantifying the risk of renal scarring in children with APN could help in planning the treatment and in modifying the later strategies.