Rushton H G, Majd M, Jantausch B, Wiedermann B L, Belman A B
Department of Urology, Children's Hospital, Washington, D.C. 20010.
J Urol. 1992 May;147(5):1327-32. doi: 10.1016/s0022-5347(17)37555-9.
99mTechnetium dimercaptosuccinic acid (DMSA) scintigraphy is the imaging modality of choice for the detection of acute pyelonephritis and chronic renal scarring in children. Using the DMSA scan we prospectively evaluated renal scarring after reflux and nonreflux pyelonephritis in children. The study population consisted of 33 patients with acute pyelonephritis documented by a DMSA renal scan at infection. The children were evaluated for renal scarring with a followup DMSA scan 4 to 42 months (mean 10.7 months) after the acute infection. All new scarring on followup DMSA scans occurred at sites corresponding exactly to areas of acute inflammation on the initial DMSA scan. Therefore, only those kidneys with acute changes on the initial scan were subsequently analyzed. Of 38 kidneys new or progressive scarring developed in 16 (42%), including 6 of 15 (40%) with associated vesicoureteral reflux and 10 of 23 (43%) without demonstrable reflux. New renal scarring developed in 6 of the 7 kidneys (86%) associated with a neuropathic bladder or posterior urethral valves. In contrast, new scarring developed in only 10 of 31 kidneys (32%) associated with a normal bladder (p = 0.028). Excluding the kidneys associated with a neuropathic bladder or posterior urethral valves, new renal scarring developed in 3 of 12 (25%) with primary reflux, compared with 7 of 19 (37%) without vesicoureteral reflux. Except for the white blood count and the species of infecting bacteria, no other statistically significant differences could be found between those cases in which scars did or did not develop. We conclude that acquired renal scarring only occurs at sites corresponding to previous areas of acute pyelonephritis, the acute parenchymal inflammatory changes of acute pyelonephritis are reversible and do not lead to new renal scarring in the majority of cases, and once acute pyelonephritis has occurred ultimate renal scarring is independent of the presence or absence of vesicoureteral reflux.
锝-99m二巯基丁二酸（DMSA）闪烁扫描术是检测儿童急性肾盂肾炎和慢性肾瘢痕形成的首选成像方式。我们使用DMSA扫描对儿童反流性和非反流性肾盂肾炎后的肾瘢痕形成进行了前瞻性评估。研究对象包括33例经感染时DMSA肾扫描证实患有急性肾盂肾炎的患者。在急性感染后4至42个月（平均10.7个月），通过随访DMSA扫描对这些儿童的肾瘢痕形成情况进行评估。随访DMSA扫描中所有新出现的瘢痕均恰好出现在与初始DMSA扫描时急性炎症区域相对应的部位。因此，仅对初始扫描有急性改变的肾脏进行后续分析。在38个肾脏中，16个（42%）出现了新的或进展性瘢痕，其中15个中有6个（40%）伴有膀胱输尿管反流，23个中10个（43%）无明显反流。与神经源性膀胱或后尿道瓣膜相关的7个肾脏中有6个（86%）出现了新的肾瘢痕。相比之下，与正常膀胱相关的31个肾脏中只有10个（32%）出现了新瘢痕（p = 0.028）。排除与神经源性膀胱或后尿道瓣膜相关的肾脏，原发性反流的12个中有3个（25%）出现了新的肾瘢痕，无膀胱输尿管反流的19个中有7个（37%）出现了新瘢痕。除白细胞计数和感染细菌种类外，瘢痕形成或未形成的病例之间未发现其他具有统计学意义的差异。我们得出结论，获得性肾瘢痕仅发生在与先前急性肾盂肾炎区域相对应的部位，急性肾盂肾炎的急性实质炎症改变是可逆的，在大多数情况下不会导致新的肾瘢痕形成，并且一旦发生急性肾盂肾炎，最终的肾瘢痕形成与膀胱输尿管反流的有无无关。
