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KMID : 1040420200240020098
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Childhood Kidney Diseases
2020 Volume.24 No. 2 p.98 ~ p.106
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Vesicoureteral Reflux and Renal Scarring in Children with Acute Pyelonephritis: the Role of Late 6-month Dimercaptosuccinic Acid Renal Scan
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Oh Kyeong-Eun
Yim Hyung-Eun
Yoo Kee-Hwan
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Abstract
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Purpose: The aim of this study is to evaluate the clinical utility of late 6-month dimercapto-succinic acid (DMSA) renal scan in predicting vesicoureteral reflux (VUR) and long-lasting renal scars in children with first acute pyelonephritis (APN).
Methods: A retrospective case study of children admitted with APN from January 2010 to July 2017 was performed. The study included patients with voiding cystourethrography (VCUG) and acute and late 6-month DMSA scan. We analyzed the clinical, laboratory and imaging findings of patients with and without late cortical defects at 6 months and those with or without VUR.
Results : Among 145 children with APN, 50 (34.5%) had cortical defects on the late DMSA renal scan and 60 (41.4%) showed VUR. Thirteen of 38 (34.2%) children undergoing 18-month DMSA renal scan showed a long-lasting renal scars. Compared with children without late cortical defects, patients with late 6-month cortical defects had a higher incidence of VUR and long-lasting renal scars, and relapse of UTI (all P<0.05). In a multivariable analysis, both high-grade VUR and relapse of UTI were independently correlated with the presence of late 6-month cortical defects (P<0.05). Late cortical defects and relapse of UTI were also associated with the presence of VUR (P<0.05). Only the late 6-mo cortical defects was an independent predictor of long-lasting renal scars in children with APN (P<0.05).
Conclusion : An abnormal late 6-month DMSA renal scan may be useful in identifying VUR and long-lasting renal scars in children diagnosed with APN.
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KEYWORD
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Renal scarring, Acute pyelonephritis, Vesicoureteral reflux, Dimercaptosuccinic acid renal scan
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