Prognostic value of the acute DMSA scan in children with first urinary tract infection |
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Authors: | Biggi A Dardanelli L Cussino P Pomero G Noello C Sernia O Spada A Camuzzini G |
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Institution: | (1) Nuclear Medicine Service, S. Croce General Hospital, via Coppino 25, 12100 Cuneo, Italy. alberto.biggi@multiwire.net, IT;(2) Pediatric Division, S. Croce General Hospital, Cuneo, Italy, IT;(3) Pediatric Division, SS Annunziata General Hospital, Savigliano, Italy, IT |
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Abstract: | 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 different risks of developing renal scarring by taking into account both the extent of kidney involvement
documented in the acute phase of infection using a dimercaptosuccinic acid (DMSA) scan, and the presence or absence of vesicoureteral
reflux (VUR). The frequency of persistent lesions in kidneys with mild-moderate lesions (less than 50% of kidney involvement)
in the presence of VUR or in non-refluxing kidneys was similar (P=0.1447), while the frequency 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
of 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 lesions 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
help in planning the treatment or in modifying the later strategy.
Received: 5 June 2000 / Revised: 23 January 2001 / Accepted: 24 April 2001 |
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Keywords: | Acute pyelonephritis Dimercaptosuccinic acid Vesicoureteral reflux Renal scarring Reflux nephropathy |
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