Goldraich N P, Goldraich I H
Department of Paediatrics, Hospital de Clinicas de Porto Alegre, RS, Brazil.
Pediatr Nephrol. 1995 Apr;9(2):221-6; discussion 227. doi: 10.1007/BF00860755.
The dimercaptosuccinic acid (DMSA) renal scan is a method for assessing kidney function. Indications for DMSA scanning in children with urinary tract infection (UTI), as well as timing, have changed. Pitfalls in interpreting DMSA scans include: (1) acute pyelonephritis (APN), (2) tubular dysfunction, (3) hypertension, (4) use of captopril in patients with renovascular hypertension and (5) duplex kidneys. Interpretation of DMSA scans in children with UTI vary according to timing and clinical setting. During the course of a febrile UTI a DMSA scan may reveal a normal kidney, APN or a non-functioning, small and/or ectopic kidney. In the absence of UTI (up to 6 months) in children with vesicoureteric reflux a DMSA scan may indicate a normal kidney, renal scarring (reflux nephropathy), occult duplex kidney and allows the progression of scarring and hypertrophy of normal areas of the kidney to be followed anatomically. The DMSA renal scan in now the most reliable test for the diagnosis of APN. The transient abnormalities due to APN can occur in normal or scarred kidneys. Lesions due to reflux nephropathy (defined as a defect in the renal outline or contraction of the whole kidney) are permanent. Intravenous urography reveals renal abnormalities later than the DMSA scan. If abnormalities are seen on a DMSA scan performed during the course of APN it is impossible to predict the outcome: they can progress to permanent scarring or heal completely. An abnormal DMSA scan during a febrile UTI allows the identification of children at risk of developing renal scars. These children should be carefully investigated, maintained on long-term quimioprophylaxis and followed.
二巯基丁二酸（DMSA）肾扫描是一种评估肾功能的方法。对患有尿路感染（UTI）的儿童进行DMSA扫描的指征以及扫描时间已经发生了变化。解读DMSA扫描结果时的陷阱包括：（1）急性肾盂肾炎（APN），（2）肾小管功能障碍，（3）高血压，（4）肾血管性高血压患者使用卡托普利，以及（5）重复肾。对患有UTI的儿童进行DMSA扫描的解读会因扫描时间和临床情况而异。在发热性UTI病程中，DMSA扫描可能显示肾脏正常、APN或无功能、小和/或异位肾。对于患有膀胱输尿管反流的儿童，在无UTI（长达6个月）的情况下，DMSA扫描可能显示肾脏正常、肾瘢痕形成（反流性肾病）、隐匿性重复肾，并能从解剖学上追踪肾脏正常区域瘢痕形成和肥大的进展情况。DMSA肾扫描现在是诊断APN最可靠的检查。APN导致的短暂异常可发生在正常或有瘢痕的肾脏中。反流性肾病导致的病变（定义为肾轮廓缺陷或整个肾脏缩小）是永久性的。静脉肾盂造影显示肾脏异常的时间比DMSA扫描晚。如果在APN病程中进行的DMSA扫描发现异常，则无法预测结果：它们可能进展为永久性瘢痕形成或完全愈合。发热性UTI期间DMSA扫描异常可识别有发生肾瘢痕风险的儿童。应对这些儿童进行仔细检查，长期进行化学预防并随访。
