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99mTechnetium-dimercaptosuccinic acid scan in the diagnosis of acute pyelonephritis in children: relation to clinical and radiological findings

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Abstract

Seventy-two children, 59 girls and 13 boys, 0.1–15.9 (median 1.1) years of age, with acute pyelonephritis (APN) were investigated with the aid of a dimercaptosuccinic acid (DMSA) scan, renal ultrasonography (US) and a desmopressin test within 5 days of admission. Sixty-two children were reinvestigated approximately 2 months later when intravenous urography (IVU) and micturition cysto-urethrography were also performed. During infection, 92% of the children showed changes in the DMSA scan with 69% by US, and the two investigations agreed in 58% of the kidneys. At follow-up, 68% showed changes in the DMSA scan, 47% by US and 48% by IVU. The DMSA scan and IVU agreed in 60% of the kidneys. Twenty-nine percent of the children had vesico-ureteric reflux (VUR). The presence of grade>-3 VUR was associated with greater defects on the DMSA scan during infection, and at follow-up with a higher frequency of persistent changes compared with no VUR (P<0.02 and 0.01, respectively). During infection the size of the defect on the DMSA scan correlated with renal vooume and C-reactive protein and inversely with the glomerular filtration rate, and at follow-up it correlated inversely with the renal concentration capacity. The DMSA scan is a sensitive method for diagnosing and localizing APN in children, and findings on DMSA scan show a weak but significant correlation with routine clinical and radiological parameters. It is suggested that persistent renal damage after APN in children without VUR may be more common than previously assumed.

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Authors and Affiliations

  1. Department of Paediatrics, Huddinge University Hospital, Karolinska Institute, 141 86, Huddinge, Sweden

    Birgir Jakobsson & Ulla Berg

  2. Department of Radiology, Huddinge University Hospital, Karolinska Institute, 141 86, Huddinge, Sweden

    Stefan Söderlundh

  3. Department of Nuclear Medicine, Huddinge University Hospital, Karolinska Institute, 141 86, Huddinge, Sweden

    Lennart Nolstedt, Leif Svensson & Stefan Söderlundh

Authors
  1. Birgir Jakobsson
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  2. Lennart Nolstedt
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  3. Leif Svensson
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  4. Stefan Söderlundh
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  5. Ulla Berg
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Jakobsson, B., Nolstedt, L., Svensson, L. et al. 99mTechnetium-dimercaptosuccinic acid scan in the diagnosis of acute pyelonephritis in children: relation to clinical and radiological findings. Pediatr Nephrol 6, 328–334 (1992). https://doi.org/10.1007/BF00869725

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  • DOI: https://doi.org/10.1007/BF00869725

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