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Can DMSA scintigraphy avoid voiding cystourethrogram in the work up of children with urinary tract infections?

¹ Nuclear Medicine, PGIMER, Chandigarh, U.T., India

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Objectives: Urinary tract infection (UTI) is one of the most common bacterial illness affecting children, particularly infants and young children. UTI is often associated with vesicoureteral reflux (VUR) or urinary tract obstruction. Frequent recurrence of UTI leads to permanent renal damage with risk of long-term complications such as uremia, hypertension and problems associated with pregnancy. Different combinations of ultrasonography, voiding cystourethrography (VCU), urography and DMSA scintigraphy are mostly used for diagnosing and managing UTI in children. Reducing the number of VCU would be of great value, as it is an unpleasant procedure and also carries greater exposure to radiation and risk of infection. This study was performed to determine if technetium-99m dimercaptosuccinic acid (DMSA) renal scintigraphy obviates the need for VCUG in evaluating young children after their first UTI.

Methods: A retrospective analysis of the records of 107 children younger than 2 years with initial UTI investigated in a tertiary care hospital with Ultrasonography, culture sensitivity, DMSA scintigraphy and VCU within 3 months after UTI was performed.

Results: In 23 of the 107 children (21%) DMSA scintigraphy showed renal lesions. VUR was found in 31 patients (29%) and VUR grade significantly correlated with the presence of renal lesions. A normal DMSA scintigraphy and dilating VUR (>grade III) occurred in 2 infants. On follow up one of these two children showed normal DMSA renal scintigraphy while other was subjected to deflux therapy and was free from renal scars on scintigraphy.

Conclusions: DMSA scintigraphy in infants with UTI may replace VCU as a first line investigation. A strategy to perform VCU in only patients with renal lesions is proposed. In this study 76 of 107 (71%) VCU would have been unnecessary.

This Article Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Vipul, P. Articles by Singh, B. PubMed Articles by Vipul, P. Articles by Singh, B.