Clinical Centre of Serbia, School of Medicine University of Belgrade, Serbia.
Ann Nucl Med. 2011 Jan;25(1):37-43. doi: 10.1007/s12149-010-0431-5. Epub 2010 Nov 16.
Assessment of the first febrile urinary tract infection (UTI) in children has been the subject of debate for many years. Diagnosis of acute pyelonephritis (APN) is usually based on clinical and biological data. The clinical usefulness of early Tc-99m DMSA scintigraphy remains controversial, although it may influence the type and duration of treatment. The aim of this study was to assess the role of initial cortical scintigraphy in the detection of early renal parenchymal damage in children highly suspected of having APN and to compare the scintigraphic findings with selected clinical/laboratory parameters and ultrasonography.
A prospective study was conducted in 34 infants and young children (18 boys, 16 girls), aged 1.5-36 months (mean 9.8 ± 8.7 months), hospitalized with a first episode of clinically suspected APN. Within the first 5 days after admission, Tc-99m DMSA renal scintigraphy, ultrasonography (US), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), white blood cell count (WBC) and urine analyses were performed.
DMSA scintigraphy showed changes consistent with APN in 27/34 (79%) patients, with a mean age of 10.9 months, including 12 males (44%) and 15 (56%) females. Out of 9 febrile children with negative urine culture and supportive evidence of UTI, scintigraphy showed parenchymal involvement in 8 children (24% in the whole group, 30% in scintigraphically documented APN). There were no statistically significant correlations between the frequency or size of the initial scintigraphic abnormalities and age, sex, body temperature, CRP levels or ESR. A CRP level of >54 mg/L and a WBC of >13,300/mm³ had sensitivities of 56 and 59% and specificities of 86 and 71%, respectively. US showed changes consistent with APN in 7/34 (21%) in the whole group and in 7/27 (26%) patients with positive cortical scan (p < 0.05).
Initial DMSA renal scintigraphy is a sensitive method for the early diagnosis of APN in young children and is useful in the assessment of the severity of kidney injury even in patients with negative urine culture. Clinical, biological and ultrasound parameters do not identify children with renal damage. Normal DMSA study, excluding parenchymal involvement and late sequelae, could minimize the use of scintigraphy in the follow-up and reduce the redundancy of cystography.
儿童首次发热性尿路感染（UTI）的评估多年来一直存在争议。急性肾盂肾炎（APN）的诊断通常基于临床和生物学数据。尽管早期 Tc-99m DMSA 闪烁扫描术可能会影响治疗的类型和持续时间，但它在检测儿童早期肾实质损伤方面的临床实用性仍存在争议。本研究旨在评估初始皮质闪烁扫描术在高度怀疑患有 APN 的儿童中检测早期肾实质损伤中的作用，并将闪烁扫描术结果与选定的临床/实验室参数和超声检查进行比较。
对 34 名 1.5-36 个月（平均 9.8±8.7 个月）龄的婴儿和幼儿（男 18 例，女 16 例）进行了前瞻性研究，这些患儿因首次出现临床疑似 APN 而住院。在入院后 5 天内进行 Tc-99m DMSA 肾闪烁扫描、超声（US）、红细胞沉降率（ESR）、C 反应蛋白（CRP）、白细胞计数（WBC）和尿液分析。
DMSA 闪烁扫描术显示 27/34（79%）例患儿的结果与 APN 一致，平均年龄为 10.9 个月，包括 12 名男性（44%）和 15 名女性（56%）。在 9 名发热且尿液培养阴性但支持 UTI 的儿童中，有 8 名儿童的闪烁扫描术显示有实质受累（在整个组中占 24%，在闪烁扫描术确诊的 APN 中占 30%）。初始闪烁扫描异常的频率或大小与年龄、性别、体温、CRP 水平或 ESR 之间无统计学显著相关性。CRP 水平>54mg/L 和 WBC>13300/mm³ 的敏感性分别为 56%和 59%，特异性分别为 86%和 71%。整个组中有 7/34（21%）和有 7/27（26%）皮质扫描阳性的患儿的 US 显示与 APN 一致（p<0.05）。
初始 DMSA 肾闪烁扫描术是诊断幼儿 APN 的一种敏感方法，即使在尿液培养阴性的患者中，也有助于评估肾脏损伤的严重程度。临床、生物学和超声参数无法识别有肾脏损伤的儿童。正常的 DMSA 研究，排除实质受累和晚期后遗症，可以最大限度地减少在随访中对闪烁扫描术的使用，并减少膀胱造影术的冗余。
