Benador D, Benador N, Slosman D O, Nusslé D, Mermillod B, Girardin E
Department of Pediatrics, Hôpital Cantonal Universitaire de Geneve, Switzerland.
J Pediatr. 1994 Jan;124(1):17-20. doi: 10.1016/s0022-3476(94)70248-9.
We designed a prospective study to evaluate the ability of dimercaptosuccinic acid cortical scintigraphy and ultrasonography to detect renal parenchymal lesions in children with pyelonephritis. One hundred eleven patients 1 week to 16 years of age (median 5.5 months) with a urine culture positive for pathogens were included in the study; cortical scintigraphy and ultrasonography were repeated in 25 children after a mean follow-up of 10.5 months. Cortical scintigraphy showed renal changes in 74 children (67%), and ultrasonography showed renal changes in 39 (35%) (p < 0.001); results of the two examinations were discordant in 49 patients (kappa = 0.19). Children more than 1 year of age had a higher incidence of renal lesions than did younger children (85% vs 66%; p = 0.04). The presence of inflammatory signs (erythrocyte sedimentation rate or C-reactive protein) had an 89% sensitivity and a 25% specificity in identifying renal lesions. Among children with renal changes, vesicoureteric reflux was present in 39%. At follow-up examination, 16 children (64%) had scars. Thus we found a high incidence of renal involvement in children with pyelonephritis. We found that cortical scintigraphy is more sensitive than ultrasonography in detecting renal changes, and we believe that it should be added to the initial examination of children with suspected pyelonephritis.
我们设计了一项前瞻性研究，以评估二巯基丁二酸皮质闪烁扫描和超声检查在检测肾盂肾炎患儿肾实质病变方面的能力。研究纳入了111例年龄在1周龄至16岁（中位数为5.5个月）、尿培养病原体阳性的患儿；25例患儿在平均随访10.5个月后重复进行了皮质闪烁扫描和超声检查。皮质闪烁扫描显示74例患儿（67%）有肾脏改变，超声检查显示39例患儿（35%）有肾脏改变（p<0.001）；49例患者的两项检查结果不一致（kappa=0.19）。1岁以上儿童的肾脏病变发生率高于年幼儿童（85%对66%；p=0.04）。炎症体征（红细胞沉降率或C反应蛋白）在识别肾脏病变方面的敏感性为89%，特异性为25%。在有肾脏改变的患儿中，39%存在膀胱输尿管反流。在随访检查时，16例患儿（64%）有瘢痕形成。因此，我们发现肾盂肾炎患儿肾脏受累的发生率很高。我们发现皮质闪烁扫描在检测肾脏改变方面比超声检查更敏感，我们认为应将其纳入疑似肾盂肾炎患儿的初始检查中。
