FEBRILE URINARY-TRACT INFECTION IN CHILDREN - ROLE OF TC-99M-DIMERCAPTOSUCCINIC ACID (DMSA) SCAN AND OTHER IMAGING TECHNIQUES

Fifty children (37 females and 13 males) with first febrile urinary tr act infections were studied to assess the value of Tc-99m-dimercaptosu ccinic acid (DMSA) scan in detecting inflammatory changes of acute pye lonephritis (APN). These findings were compared with renal ultrasonogr aphy (US). We also evaluated the reliability of clinical and laborator y observations in diagnosing acute pyelonephritis (APN). All children had micturating cystourethrography. (MCUG). DMSA-documented acute pyel onephritis was present in 29 (58%) patients. Only four children (8%) d emonstrated changes suggestive of APN on renal ultrasonography. Vesico ureteric reflux (VUR) was documented in 17 (47%) of the total group an d in 13 (45%) of those with abnormal DMSA scan. Follow-up DMSA scan in 15 children with initial abnormal findings showed complete recovery i n seven (47%). Our data have shown that DMSA renal scan is the most us eful investigational procedure in children with febrile UTI. The diagn osis 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 ch ildren with UTI and abnormal DMSA scan. Early detection of acute pyelo nephritis allows the prompt introduction of antimicrobial agents in th ose children and can prevent or decrease renal damage and its complica tions.