The etiology of renal scars in infants with pyelonephritis and vesicoureteral reflux |
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Authors: | M Goldman T Bistritzer T Horne I Zoareft M Aladjem |
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Institution: | (1) Department of Pediatrics ’B’, Assaf Harofeh Medical Center, 70300 Zerifin, Israel Tel.: +972-8-9779132, Fax: +972-8-9770136, IL;(2) Department of Nuclear Medicine, Assaf Harofeh Medical Center (affiliated to the Sackler Faculty of Medicine, Tel Aviv University), 70300 Zerifin, Israel, IL;(3) Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel, IL |
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Abstract: | We aimed to investigate, by means of dimercaptosuccinic acid (DMSA) scan, the relations between vesicoureteral reflux (VUR)
and its degree, pyelonephritis during infancy, and renal parenchymal findings. Seventy-four infants with pyelonephritis, 44
girls and 30 boys (mean age at their first pyelonephritic episode 4.12 months, median 3 months), were enrolled in the study.
Voiding cystourethrography (VCU) and ultrasonography (US) were performed within 6 weeks following the infection. DMSA was
performed at least 4 months after the urinary tract infection (UTI). The renal parenchymal pathology was defined as focal
or multifocal defects or as a split renal uptake of less than 45%. DMSA scintigraphy revealed that 19% (14/74) of the children
had renal damage. Renal parenchymal findings were observed only when VUR was present, and its grade was above 3/5. No abnormality
was found in 51 renal units without reflux, 9 with VUR grade 1/5, and 54 with grade 2/5. Renal pathology was observed in 9/24
renal units with VUR grade 3, 3/8 with grade 4, and 2/2 with grade 5. No correlation was found between renal parenchymal defects
and clinical presentation of the pyelonephritis, type of the microorganism, presence of bacteremia, or the number of recurrent
infections. In adequately treated infants, renal damage is probably due to a reflux-associated, preexisting, congenital renal
parenchymal pathology and not to the inflammatory process. We suggest that DMSA scintigraphy should not be performed routinely
in every infant with UTI and should be reserved primarily for children with VUR grade 3 and above.
Received: 17 February 1999 / Revised: 30 June 1999 / Accepted: 7 July 1999 |
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Keywords: | Urinary tract infection Vesicoureteral reflux Renal scars Dimercaptosuccinic acid |
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