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Korean J Pediatr 1995 September;38(9) :1242-1252.
Analysis of Radiologic Findings in Children with Urinary Tract Infection
Won Suk Kuk (Kuk WS), Il Kyung Kim (Kim IK), Ho Seong (Seong H), Chang Hee Choi (Choi CH)
Department of Pediatrics, Seoul Adventist Hospital Seoul, Korea
Copyright © 1995 by The Korean Pediatric Society
Purpose : Because some patients with urinary tract infection (UTI) may combine vesicoureteral reflux and progress to reflux nephropathy, the early diagnosis and treatment of UTI are important. We have performed this study to recognize the meaning of the radiologic examination centering around technetium 99m- labelled dimercaptosuccinic acid renal scan(DMSA scan) in pediatric UTI patients. Methods : We have studied 55 patients with UTI, who were admitted to the Department of Pediatrics Seoul Adventist Hospital from May 1990 to May 1993. Initially renal sonography and DMSA renal scan were performed just after the diagnosis. For male, voiding cystourethrography(VCUG) were performed in all the cases, and for females, VCUG were performed in the cases who were suspected recurrent UTI. Intravenous pyelography(IVP) were performed only when there had been any abnoumalities in above three studies. Results : The results were as follows 1) The frequency of UTI was the highest in the children from one to six years old(54.5%). The ratio of male and female patients was 1.6:1 under the age of one year, and was 1:1.6 over the age of one year. 2) E. Coli was the most common causative organism(72.7%), and was followed by Klebsiella(10.9%), Proteus(7.2%), and others. 3) Among 55 cases who was carried radiologic examinations 25 cases showed abnormal findings(42%). Ultrasonography showed 15 abnormal cases among 45 cases(33%), DMSA scan showed 16 abnormal cases among 42 cases (38%), Intravenous pyelogram showed 11 abnormal cases among 23 cases and voiding cystourethrogram showed 15 abnormal cases among 25 cases respectively. 4) In analysis of 22 renal units of 15 cases who showed vesicoureteral reflux on VCUG, grade II was 8 cases, grade III was 5, grade IV was 6, and grade V was 3 respectively by international reflux study classification. 5) In analysis of 18 renal units of 16 patients who showed renal scarring on DMSA scan, type A(mild scar; not more than two scarred areas) was 7 cases, type B(severe, multiple scars) was 4, type C(irregular thinning of renal tissue) was 5, and type D(end-stage, contracted kidney) was 2 respectively by Smellie's classification. 6) The more severe the extent of reflux, the more severe the renal scar on DMSA scan. 7) Sensitivity and specificity of renal sonography to intravnous pyelogram were 69% and 84% respectively, and sensitivity and specificity of renal sonography to VCUG were 45% and 82% respectively. 8) Sensitivity and specificity of DSMA scan to intravenous pyelogram were 100% and 71% respectively, and sensitivity and specificity of DMSA scan to VCUG were 59% and 69% respetively. Conclusion : To prevent reflux nephropathy by early and accurate diagnosis of renal scarring and vesicoureteral reflux, appropriate radiologic evaluations should be done in patients with UTI. Especially DMSA scan seems to be best radiologic method to predict diagnosis and severity of renal scarring.
Keywords: UTI | Renal scar | Reflux nephropathy | DMSA scan
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