Kanaan Nadin, Cooper Shiri, Landau Daniel, Sever Zvi Bar, Haskin Orly
Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah-Tikva, Israel.
Institute of Nephrology, Schneider Children's Medical Center of Israel, Petah-Tikva, Israel.
Pediatr Nephrol. 2025 Apr 28. doi: 10.1007/s00467-025-06779-1.
Tc-Dimercaptosuccinic acid (DMSA) scan is highly accurate for assessing functional imaging of the kidney parenchyma. Kidney damage observed on DMSA scan is associated with future development of chronic kidney disease. This study aims to differentiate between different patterns of damage observed on DMSA scan and determine their predictive clinical value.
We reviewed first-in-life DMSA scans performed ≥ 4 months post febrile urinary tract infection (UTI) or for suspected congenital kidney abnormalities, in a single referral center, from November 2007 to February 2011. DMSA uptake patterns were classified as normal; peripheral focal defects; diffuse inhomogeneity in tracer distribution within kidney parenchyma; and the combination of both patterns. Subsequent UTIs and estimated glomerular filtration rate (eGFR) were recorded at last follow-up.
One hundred five patients met inclusion criteria, and 57 (54%) were females. Median (IQR) age at scan was 2 (1.3, 5.1) years. Fourteen patients (13.3%) had focal defects, 29 (27.6%) had diffuse inhomogeneity and 9 (8.6%) had diffuse inhomogeneity with focal defects. After a mean follow-up period of 9.6 ± 3.3 years (available for 99 children), 29 (29%) patients experienced recurrent UTIs [median (IQR) episodes: 2 (1, 5)]. UTI tendency differed between groups (focal defects: 71.4%; diffuse inhomogeneity with focal defect: 44.4%; diffuse inhomogeneity only: 22.2%; normal scan: 18.3% p < 0.001). On multivariate analysis only the presence of focal defects predicted recurrent UTIs [OR (95%CI): 3.89 (1.2, 12.6), p = 0.024]. The percentage of patients with an eGFR < 75 ml/min/1.73 m, was highest in patients with diffuse inhomogeneity with focal defects compared to patients with normal scans, focal defects only or diffuse inhomogeneity only (22% vs. 2%, 0% and 3.7% respectively, p = 0.032).
Focal defects on DMSA scan, likely representing post pyelonephritis scars, are a strong predictor of recurrent UTIs. Patients with diffuse inhomogeneity with focal defects on scan have the highest risk of reduced eGFR during follow-up.
锝-二巯基丁二酸（DMSA）扫描在评估肾实质功能成像方面具有高度准确性。DMSA扫描中观察到的肾损伤与慢性肾脏病的未来发展相关。本研究旨在区分DMSA扫描中观察到的不同损伤模式，并确定其预测临床价值。
我们回顾了2007年11月至2011年2月在单一转诊中心进行的首次生命期DMSA扫描，这些扫描是在发热性尿路感染（UTI）后≥4个月进行的，或用于疑似先天性肾脏异常。DMSA摄取模式分为正常；周边局灶性缺损；肾实质内示踪剂分布的弥漫性不均匀；以及两种模式的组合。在最后一次随访时记录随后的UTI情况和估计肾小球滤过率（eGFR）。
105名患者符合纳入标准，57名（54%）为女性。扫描时的中位（IQR）年龄为2（1.3，5.1）岁。14名患者（13.3%）有局灶性缺损，29名（27.6%）有弥漫性不均匀，9名（8.6%）有弥漫性不均匀伴局灶性缺损。在平均随访9.6±3.3年（99名儿童可用）后，29名（29%）患者经历了复发性UTI [中位（IQR）发作次数：2（1，5）]。各组间UTI倾向不同（局灶性缺损：71.4%；弥漫性不均匀伴局灶性缺损：44.4%；仅弥漫性不均匀：22.2%；扫描正常：18.3%，p<0.001）。多因素分析显示，只有局灶性缺损的存在可预测复发性UTI [OR（95%CI）：3.89（1.2，12.6），p = 0.024]。与扫描正常、仅局灶性缺损或仅弥漫性不均匀的患者相比，弥漫性不均匀伴局灶性缺损的患者中eGFR<75 ml/min/1.73 m²的百分比最高（分别为22% vs. 2%、0%和3.7%，p = 0.032）。
DMSA扫描中的局灶性缺损可能代表肾盂肾炎后瘢痕，是复发性UTI的有力预测指标。扫描显示弥漫性不均匀伴局灶性缺损的患者在随访期间eGFR降低的风险最高。
