Fahimi D, Khosroshahi N, Al Hossein S M, Amin Nejad M, Ansari M,
Volume 61, Issue 6 (9-2003)
Abstract
Acute Pyelonephritis (APN) is one of the most common bacterial infections seen in children that may lead to renal scarring. Vesicoureteral reflux (VUR) is an important risk factor of renal damage but not the only one.
Materials and Methods: In order to determine the association between dimercaptosuccinic acid (DMSA) scintigraphic and voiding cystourethrographic findings, a retrospective study was performed on 50 children (100 renal units) with APN that had been admitted to Bahrami Hospital from 1995 through 1998. Voiding cystourethrography (VCUG) and DMSA scan were performed in all patients within 1 to 2 weeks after termination of treatment and a second scan was performed 6 months later in patients whose kidneys showed cortical defects in the first one. The grade of reflux was based on international reflux classification (I-V). The DMSA scans were considered abnormal if one or more areas of decreased cortical uptake were noted (cortical defect). The scar was defined as persistence of these defects in the second scan. DMSA cortical defect and VUR were demonstrated in 42 (42%) and 26 (26%) of renal units respectively.
Results: Fourteen out of 26 renal units (54%) with reflux had cortical defects and 28 out of 74 renal units (38%) without reflux had cortical defects (P=0.15). Permanent renal scarring was noted in 25/ 42 of renal units (62 %) in second scan.
Conclusion: It seems that VCUG alone is insufficient as a screening modality to identity those kidneys at risk of damage and DMSA scan may provide additional information about this.
Zarabi V, Noorbakhsh S, Rahim Zadeh N, Samimi K, Ghafori M, Jafarian A, Tabatabaei A,
Volume 69, Issue 2 (5-2011)
Abstract
Background: Urinary tract infection 0 in children causes renal scarring and permanent damage to the organ. In this study, we compared the diagnostic value of magnetic resonance urogram for urinary tract anomalies with other conventional imaging methods in children with UTI.
Methods: In this case-control study, 190 children (mean age 3.23±3.59 yrs) with UTI were recruited from the Pediatric Ward of Rasul-e-Akram Hospital during 2007-2009. The patients were divided into two groups based on the applied imaging technique: MRU (cases) and conventional imaging groups (controls).
Results: Abnormal imaging detection rates for Ultrasonography were 32%, X-ray of kidneys, ureters and bladder (KUB) 9%, Intravenous Pyelogram (IVP) 26%, Voiding Cystoure therogram (VCUG) 54%, Dimercaptosuccinic Acid scan (DMSA) indicating
non-obstructive (reflux) uropathy in 76% (mean age 3.5 yrs) and MRU 43% (mean age
1.6 yrs), respectively. A meaningful correlation was observed between MRU and DMSA scan with IVP results (Kappa=0.75). KUB and Ultrasonography had similar results in cases with abnormal MRU and DMSA scan (P=0.121). MRU had strong agreement with VCUG and IVP for the detection of obstructive uropathy and scar due to congenital malformation even during intrauterine life but not with sonography results.
Conclusion: Sonography had poor results for the diagnosis of urinary tract anomalies in comparison with MRU. Use of dynamic MRU for the diagnosis of congenital anomalies (hydronephrosis, obstruction, pyelonephritis, renal scar) in children with UTI seems to be of better help, although higher costs and the need for sedation during MRU still are its disadvantages
