CORTICAL SCINTIGRAPHY IN THE EVALUATION OF RENAL PARENCHYMAL CHANGES IN CHILDREN WITH PYELONEPHRITIS

We designed a prospective study to evaluate the ability of dimercaptos uccinic acid cortical scintigraphy and ultrasonography to detect renal parenchymal lesions in children with pyelonephritis. One hundred elev en patients 1 week to 16 years of age (median 5.5 months) with a urine culture positive for pathogens were included in the study; cortical s cintigraphy and ultrasonography were repeated in 25 children after a m ean follow-up of 10.5 months. Cortical scintigraphy showed renal chang es in 74 children (67%), and ultrasonography showed renal changes in 3 9 (35%) (p < 0.001); results of the two examinations were discordant i n 49 patients (kappa = 0.19). Children more than 1 year of age had a h igher incidence of renal lesions than did younger children (85% vs 66% ; p = 0.04). The presence of inflammatory signs (erythrocyte sedimenta tion rate or C-reactive protein) had an 89% sensitivity and a 25% spec ificity in identifying renal lesions. Among children with renal change s, vesicoureteric reflux was present in 39%. At follow-up examination, 16 children (64%) had scars. Thus we found a high incidence of renal involvement in children with pyelonephritis. We found that cortical sc intigraphy is more sensitive than ultrasonography in detecting renal c hanges, and we believe that it should be added to the initial examinat ion of children with suspected pyelonephritis.