Temiz Y, Tarcan T, Onol F F, Alpay H, Simşek F
Department of Pediatric Urology, Marmara University School of Medicine, Istanbul, Turkey.
Int Urol Nephrol. 2006;38(1):149-52. doi: 10.1007/s11255-005-3829-6.
Pyelonephritis-induced renal scarring in children is a major predisposing factor for proteinuria, hypertension, and ultimate renal failure. The aim of this study was to investigate and compare the efficacy of Tc99m dimercaptosuccinic acid (Tc-DMSA) renal scintigraphy and renal ultrasonography (USG) in detecting renal scars in children with primary vesicoureteral reflux (VUR).
Tc-DMSA scan and USG studies were done in 62 children who were admitted to our clinic between 1997 and 2003 because of documented urinary tract infection (UTI) and diagnosed with primary VUR. Renal scarring detection rates of Tc-DMSA scan and USG were compared according to reflux grades.
In the whole group, renal scars were detected by Tc-DMSA scan and USG in 55% and 38% of refluxing units, respectively. Detection rates of Tc-DMSA and USG according to reflux grades were as follows: 47% and 29 % in low-grade VUR (grades 1 and 2), 46 % and 25% in mid-grade VUR (grade 3), 76% and 65% in high-grade VUR (grades 4 and 5), respectively.
USG was found to be an inappropriate study in the detection of renal parenchymal scars, irrespective of the reflux grade. In this study, Tc-DMSA scan detected scars in 35% of kidneys reported to be normal on USG.
儿童肾盂肾炎所致肾瘢痕是蛋白尿、高血压及最终肾衰竭的主要诱发因素。本研究旨在调查并比较锝-99m二巯基丁二酸（Tc-DMSA）肾闪烁显像和肾脏超声检查（USG）在检测原发性膀胱输尿管反流（VUR）患儿肾瘢痕方面的疗效。
对1997年至2003年间因有记录的尿路感染（UTI）入院并诊断为原发性VUR的62例患儿进行了Tc-DMSA扫描和USG检查。根据反流分级比较了Tc-DMSA扫描和USG对肾瘢痕的检测率。
在整个研究组中，Tc-DMSA扫描和USG分别在55%和38%的反流单位中检测到肾瘢痕。根据反流分级，Tc-DMSA和USG的检测率如下：低度VUR（1级和2级）分别为47%和29%，中度VUR（3级）分别为46%和25%，高度VUR（4级和5级）分别为76%和65%。
无论反流分级如何，USG被发现不适用于检测肾实质瘢痕。在本研究中，Tc-DMSA扫描在USG报告为正常的35%的肾脏中检测到了瘢痕。
