Prognostic value of the acute DMSA scan in children with first urinary tract infection

We attempted to verify in a group of 101 children with first urinary tract infection whether it was possible to identify groups of patients with diffe rent risks of developing renal scarring by taking into account both the ext ent of kidney involvement documented in the acute phase of infection using a dimercaptosuccinic acid (DMSA) scan, and the presence or absence of vesic oureteral reflux (VUR). The frequency of persistent lesions in kidneys with mild-moderate lesions (less than 50% of kidney involvement) in the presenc e of VUR or in non-refluxing kidneys was similar (P=0.1447), while the freq uency of persistent lesions in kidneys with severe lesions in the presence of VUR was significantly higher than the frequency of persistent lesions in non-refluxing kidneys (P=0.0089). The extent of kidney involvement and the presence of VUR make possible the identification of different categories o f risk of scarring: in the "low risk group" (normal kidney with/without VUR ) the risk of scarring is 0%; in the "intermediate risk group" (mild lesion s with/without VUR; extensive lesions without VUR) the risk of scarring is between 14% and 38% while in the "high risk group" (extensive lesions with VUR) the risk of scarring is 88%. Quantifying the risk of scarring could he lp in planning the treatment or in modifying the later strategy.