Department of Nephrology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, Zhejiang Province, China.
Department of Ultrasonics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, Zhejiang Province, China.
BMC Nephrol. 2021 May 17;22(1):181. doi: 10.1186/s12882-021-02390-2.
The purpose of this study was to evaluate the clinical value of color and power doppler sonography (CPDS) when combined it with 99mTc-dimercaptosuccinic acid scintigraphy (DMSA) in assessment of acute pyelonephritis (APN) in infants.
A total of 79 children with APN admitted to our hospital from June 2016 to Jan 2019 were enrolled, including 52 boys and 27 girls, age range 1 month to 3 years old. All cases followed the diagnostic criteria for acute pyelonephritis and excluded anatomical abnormalities of urinary system. All 79 patients were examined by urinary ultrasonography (US), CPDS, and DMSA within 48 h of fever and analyzed the clinical value of combining the two methods in the assessment of APN in infants.
Among 79 children, urinary ultrasonography revealed 2 cases of renal cortical echo changes, both located in the upper pole of the kidney, 24 cases of kidney enlargement, and 1 case of left kidney shrinkage. Ninety-five kidneys were shown to be diseased with DMSA, while 105 kidneys abnormal by CPDS. The sensitivity of CPDS was 69.4%, and the specificity was 38.1%. In children younger than 6 months, the sensitivity of CPDS was 56.9%, which was 84.2% in childeren between 6 months to 1 year, and 94.4% from 1 to 3 years old, respectively. The corresponding specificity of CPDS was 44.1, 26.7, and 35.7%. There was no significant correlation between CPDS levels and DMSA positive results. The abnormal rate of intermediate part in the kidneys was significantly lower than that in the upper and lower poles. Children with abnormal CPDS have a greater risk of renal scarring(p < 0.05).
Abnormalities detected by CPDS in a cohort of infants with APN poorly correlated with DMSA findings. But the sensitivity of CPDS is highly age-related, it can be used as a non-invasive helpful tool for early diagnosis of acute pyelonephritis in infants older than 6 months old.
本研究旨在评估彩色和能量多普勒超声（CPDS）与 99mTc-二巯丁二酸闪烁扫描（DMSA）联合应用于评估婴儿急性肾盂肾炎（APN）的临床价值。
2016 年 6 月至 2019 年 1 月，我院收治的 79 例 APN 患儿，男 52 例，女 27 例，年龄 1 个月至 3 岁。所有病例均符合急性肾盂肾炎的诊断标准，排除泌尿系统解剖异常。79 例患儿均于发热后 48h 内行尿超声（US）、CPDS 和 DMSA 检查，分析两种方法联合评估婴儿 APN 的临床价值。
79 例患儿中，超声检查发现肾皮质回声改变 2 例，均位于肾上极，肾脏增大 24 例，左肾缩小 1 例。95 例肾脏 DMSA 异常，105 例 CPDS 异常。CPDS 的灵敏度为 69.4%，特异性为 38.1%。6 个月以下儿童 CPDS 灵敏度为 56.9%，6 个月至 1 岁儿童为 84.2%，1 至 3 岁儿童为 94.4%，相应 CPDS 特异性为 44.1%、26.7%和 35.7%。CPDS 水平与 DMSA 阳性结果无显著相关性。肾中部异常率明显低于上、下部。CPDS 异常的患儿发生肾瘢痕的风险更大（p<0.05）。
CPDS 在一组 APN 婴儿中的异常与 DMSA 结果相关性差。但 CPDS 的灵敏度与年龄高度相关，可作为 6 个月以上婴儿急性肾盂肾炎早期诊断的一种非侵入性的辅助手段。
