Tehran University Medical Journal

---

Background: Early diagnosis of renal parenchymal involvement in children with acute pyelonephritis (APN) using isotope scan and early treatment may decrease or prevent development of renal parenchymal lesions. We designed this study to assess the diagnostic value of certain biologic parameters in children with first- episode of acute pyelonephritis (APN) documented by 99m Tc-dimercaptosuccinic acid (DMSA) scintigraphy.
Methods: We compared the laboratory findings of leukocyte count, erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP) levels with the results of the DMSA scans obtained within three days of admission. One hundred-two children (93 girls and 9 boys aged 1 month–12 years (mean 2.85±2.92 years) were enrolled in the study. Of these patients, 203 renal units, were investigated using scintigraphy. Voiding cystourethrography (VCUG) was performed in 98 children (195 renal unit) when urine culture became negative.
Results: In all children one or both of kidneys had parenchymal involvement on scintigraphy. Changes on the DMSA scan were found in 178(88%) renal units during the acute phase. The extent of changes in DMSA scan were mild in 113/178(55.7%) renal units, moderate in 40/178(19.7%) and severe in 25/178(12.3%). When inflammatory markers were correlated with the development of the severe renal lesions, as assessed with DMSA scan, a highly significant correlation with both ESR (p=0.007) and leukocyte counts (p=0.02) were found.
conclusions: We conclude that the incidence of renal parenchymal involvement in Iranian children with APN is very high. Although increased ESR and leucocytosis may be valuable markers for determination of severe renal parenchymal involvement, but these parameters and also CRP, were inadequate in distinguishing mild to moderate renal parenchymal involvement.

---

Background: Urinary tract infection is a common infectious disease in children and associated with the risk for renal scarring and long-term complications, usually consists of pyelonephritis and may cause complications such as scars in kidney, hypertension and renal failure. Some studies demonstrated association between urinary tract infection and electrolyte disturbances such as hyponatremia. The present study has been designed for assessment of association between urinary tract infection and hyponatremia in children.

Methods: This is a descriptive, cross-sectional study has been conducted on 120 children have referred to the Golestan Hospital, Ahvaz Jundishapur University of Medical Science from 21 March 2011 until 20 March 2013. A total of 120 children who were aged 6 months to 12 years and had febrile urinary tract infection. The study population and were classified into two group of sixty children: hyponatremic and nonhyponatremic. We compared the laboratory findings in two groups with each other. The data included serum sodiom level, white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and ddimercaptosuccinic acid (DMSA) scan results collected from children with febrile urinary tract infections admitted in pediatric ward. Data analysis was performed using descriptive statistics, chi-square and independent T-test with SPSS software, ver. 20 (IBM, Armonk, NY, USA).

Results: In this study, 120 patients, 104 females (86.7%) and 16 males (13.3%) aged six months to 12 years were evaluated. All the patients were studied in terms of positive DMSA Scan. In the first group (hyponatremic) 31, and the second group (without hyponatremia) 13 patients were identified. There was a significant association between hyponatremia and WBC count, ESR, CRP, duration of fever and abnormal DMSA scan. Conclusion: We conclude that there is significant association between hyponatremia and severity of urinary tract infection in children.