Combined [99mTc]DMSA kidney scintigraphy and [131I]hippuran renography in children with urinary tract infections.

Combined [99mTc]DMSA kidney scintigraphy and [131I]hippuran renography were performed consecutively in 87 children with recurrent urinary tract infections in a retrospective study. This procedure allows a description of renal cortical morphology, split function determination and run-off evaluation. Signs of cortical scarring were found in 41 of 172 kidneys (24%) and were significantly associated with vesico-ureteral reflux (p less than 0.001) and with delayed urinary run-off (p less than 0.01). Split renal function was significantly reduced in kidneys with unilateral scarring (p less than 0.001). The radio-isotope investigations and intravenous urography were performed within 3 months of each other in 56 patients (110 kidneys). Good agreement between the findings was found except for 13 kidneys, where cortical activity defects were revealed by scintiscan despite normal urography. The extended scintigraphic procedure described is considered useful for urological screening of children with urinary tract infections and may thus replace urography as a first-line investigation. It should be followed by micturition cysto-urethrography when evaluation for vesico-ureteral reflux is indicated.