Showing 4 results for Pyelonephritis
Ataei N, Compani F, Madani A, Rezaei N ,
Volume 60, Issue 3 (6-2002)
Abstract
Background: Urinary tract infection is a common bacterial infection in children and may lead to irreversible renal damage. TC 99-m Dimercaptosuccinic acid renal scintigraphy is the most sensitive method for diagnosing acute pyelonephritis. We designed a study to evaluate the ability of DMSA scan and ultrasonography to detect renal paranchymal lesion.
Materials and Methods: 62 children 1 month to 12 years of age with the first episode of acute pyelonephritis were prospectively studied with DMSA scan and ultrasonography during acute phase of infection. A Voiding Cystourethrogram was performed in 60 children when urine culture became negative. Children with renal paranchymal changes were older at the time of acute pyelonephritis (P=0.04) but no difference was found between the groups with regard to levels of CRP, ESR (P>0.05).
Results: Changes on the DMSA scan were found in 106 (85.5 percent) kidneys of 62 children but ultrasonography showed renal changes in 19.4 percent (sensitivity=20 percent, specificity=83 percent) (Kappa=0.06). Vesicoureteric reflux was found in 14 children (23.3 percent) but 83 percent of the affected kidneys were drained by non-refluxing ureters.
Conclusion: It is concluded that DMSA scan is more sensitive than ultrasonography in detecting renal paranchymal changes in acute pyelonephritis and we found out that renal paranchymal changes after acute pyelonephritis is common, even in those without VUR.
Ataei N, Safaian B, Madani A, Esfahani St, Ataei F,
Volume 67, Issue 2 (5-2009)
Abstract
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.
Fatemeh Khanali , Mahdokht Mehramiz, Reza Dalirani , Elnaz Parsarad, Banafsheh Arad,
Volume 78, Issue 10 (1-2021)
Abstract
Background: Urinary tract infection (UTI) is one of the most important pediatric health problems, which is occasionally associated with irreversible renal damage. Dimercapto-succinic acid (DMSA) scan is a diagnostic standard for the renal scar. Doppler ultrasonography (D.S) has been considered as a less invasive method. The purpose of this study was to determine the sensitivity and specificity of D.S in the diagnosis of renal scarring in children with a history of acute pyelonephritis (APN).
Methods: The present cross-sectional study was conducted on 120 children with APN, aged six months to twelve years in the University Pediatric Hospital of Qazvin, Iran, between August 2017 and August 2018. DMSA scan was performed in the acute phase of pyelonephritis for all patients. Half of the children with acute pyelonephritis had decreased radionuclide uptake in the first DMSA scan of whom thirty patients had kidney scarring in the second scan, six months later. Then renal vascular D.S was performed for these patients. Simultaneously, twenty children with a normal DMSA scan, assigned for D.S.
Results: The mean age of children was 5.30(3.50-11.8), and 4.80(2.50-10.09) in the scar and control group. Most of the patients in both groups were female, 25(83.8%) in renal scar, and 15(75.0%) in control. The scar group showed a greater rate of vesicoureteral reflux, 17(56.6%), of whom 11(36.7%) were bilateral. Among 30 patients with a renal scar, 2(6.7%) had first-time acute pyelonephritis, 11(36.7%) had second, and 17(56.7%) had more than two attacks of pyelonephritis. The frequency of renal scarring was 25% based on DMSA scan and 14% based on D.S. Accordingly, the sensitivity and specificity of D.S in the detection of renal scarring in children with APN was 23.3% and 100%.
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Conclusion: Doppler ultrasonography is not a suitable method for diagnosis of renal scarring in children, due to the low sensitivity and negative predictive value of this device in the detection of renal scarring in children with UTI. However, normal Doppler sonography can predict that the patient did not have a kidney scar.
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Saeedeh Parvaresh, Ahmad Enhesari , Seyed Ali Moafi, Maedeh Jafari , Fatemeh Karami Robati,
Volume 79, Issue 11 (2-2022)
Abstract
Background: Vesicoureteral reflux (urinary reflux) is one of the most common congenital anomalies in children. This study aimed to compare the ureteral opening distance from the midline in children with vesicoureteral reflux (VUR) and healthy children
Methods: This cross-sectional study was performed on the children with pyelonephritis who were referred to Afzalipour Hospital in Kerman, Iran from August 2019 to August 2020. Twenty children with vesicoureteral reflux (urinary reflux) and twenty healthy children were randomly selected. Then children with vesicoureteral reflux (urinary reflux) and healthy children were divided into two groups. The distance from the ureter to the midline in these children was then measured by a radiologist with a Philips affinity 70 ultrasound machine.
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Results: In both groups (healthy children and ones with vesicoureteral reflux), ninety-five percent of the children were girls. The mean age of the children in the second group (the children with urinary reflux) was 5.8±2.58 years and the mean age of the children in the first group (the healthy children) was 4.75±1.54 years. The mean age difference between the children with urinary reflux and healthy children was not statistically significant (P=0.127). The mean distance of the ureter from the midline in children with vesicoureteral reflux was 11.44±2.60 mm and the mean distance of the ureter from the midline in healthy children was 9.32±2.74 mm. The mean difference distance of the ureter from the midline in children with vesicoureteral reflux (VUR) and healthy children was statistically significant (P=0.002).
Conclusion: Considering that the distance between the ureter and the midline in patients with urinary reflux is significantly longer than non-reflux ureters, it can be used as a non-invasive method for the diagnosis of vesicoureteral reflux (urinary reflux) in children.
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