EVALUATION OF DMSA SCINTIGRAPHY AND UROGRAPHY IN ASSESSING BOTH ACUTEAND PERMANENT RENAL DAMAGE IN CHILDREN

Purpose: To evaluate dimercaptosuccinic acid (DMSA) scintigraphy and u rography in the detection of renal involvement in children with urinar y tract infection (UTI) in order to identify patients with a high risk of developing renal damage. Material and Methods: A total of 157 chil dren (median age 0.4 years, range 5 days to 5.8 years) with first-time symptomatic UTI were examined scintigraphy (with an assessment of ren al area involvement) and urography at the time of UTI and 1 year later . All evaluations were made blindly. Results: Of the total 314 kidneys , 80 (25%) were abnormal at initial scintigraphy. Of these 80 kidneys, 44 (55%) had normalized at follow-up. Of the 234 initially normal kid neys, 29 (12%) were abnormal at follow-up. One year after UTI, abnorma lities were seen in 59 children at scintigraphy and in 18 children at urography. Renal area involvement was larger and split function abnorm alities more common in kidneys that were abnormal at both scintigraphy and urography than in kidneys with only scintigraphic abnormalities. Conclusion: Quantitation of renal area involvement and split renal fun ction at early scintigraphy would seem to be useful in identifying pat ients at risk of developing renal damage. Urography at 1 year after in fection identified mainly those with the most severe scintigraphic abn ormalities. The clinical importance of scintigraphic abnormalities tha t are not confirmed by urography is not known.