THE EVALUATION OF ACUTE PYELONEPHRITIS AND RENAL SCARRING WITH TECHNETIUM 99M-DIMERCAPTOSUCCINIC ACID RENAL SCINTIGRAPHY - EVOLVING CONCEPTS AND FUTURE-DIRECTIONS

Technetium 99m-dimercaptosuccinic acid (DMSA) scintigraphy has emerged as the imaging agent of choice for the detection and evaluation of ac ute pyelonephritis and renal cortical scarring in children. Consequent ly, DMSA scintigraphy provides a unique opportunity to study the progr ession of renal damage and functional loss from the initial insult of acute pyelonephritis to the subsequent development of irreversible ren al scarring. Over the last few years, clinical and experimental invest igations using DMSA renal scintigraphy have provided new insights into the etiology, pathophysiology, and clinical outcome of acute pyelonep hritis in children. These studies have confirmed the primary role of t he acute inflammatory response, associated with both reflux and nonref lux pyelonephritis, in the etiology of irreversible renal scarring. Fu rthermore, several studies have shown that renal scarring can be preve nted or diminished by the early diagnosis and treatment of pyelonephri tis. This review highlights these recent observations and makes recomm endations regarding current clinical and future research applications.