Almeida H N, Ribeiro M, Colarinha J, Santos J F, Rosa F C
Unidade de Nefrologia Pediátrica, HSM-Universidade de Lisboa.
Acta Med Port. 1993 Feb;6(2):59-63.
When studying a child with urinary tract infection it is important to detect and localize any renal (scar) or urologic anomaly. Here we study the information obtained using: renal and vesical ultrasound (US), DMSA scan and radiologic or isotopic cystogram.
We studied 148 children with more than one urinary tract infection and/or pyelonephritis; their mean age was 35.9 months (1-148 months); 55% were girls. The three diagnostic examinations--US, DMSA scan and cystogram were made in the order; the DMSA scan or cystogram was never made sooner than one month after the UTI.
In 42% of the children the three exams were normal; 4 of these children had another UTI and the urodynamic study revealed vesical disfunction. 11% had renal scars (DMSA scan) with normal US and cystogram; 30% had VUR, 50% of which had an altered US and 57% had renal scars on the DMSA scan. 12% of the children had an altered US with a cystogram showing no VUR; 66% of these had renal scars. 4% had vesical anomalies on the US and cystogram.
The three exams chosen were able to direct the diagnostic approach of UTI, being sufficient in most of the cases. We would like to emphasize the importance of the DMSA scan in diagnosing unsuspected renal scars.
在研究患有尿路感染的儿童时，检测并定位任何肾脏（瘢痕）或泌尿系统异常非常重要。在此，我们研究通过以下方法获得的信息：肾脏和膀胱超声（US）、二巯基丁二酸（DMSA）扫描以及放射学或同位素膀胱造影。
我们研究了148名患有不止一次尿路感染和/或肾盂肾炎的儿童；他们的平均年龄为35.9个月（1 - 148个月）；55%为女孩。三项诊断检查——超声、DMSA扫描和膀胱造影按顺序进行；DMSA扫描或膀胱造影从未在尿路感染后不到一个月进行。
42%的儿童三项检查均正常；其中4名儿童再次发生尿路感染，尿动力学研究显示膀胱功能障碍。11%有肾脏瘢痕（DMSA扫描），超声和膀胱造影正常；30%有膀胱输尿管反流（VUR），其中50%超声异常，57%在DMSA扫描时有肾脏瘢痕。12%的儿童超声异常，膀胱造影显示无VUR；其中66%有肾脏瘢痕。4%的儿童超声和膀胱造影显示有膀胱异常。
所选择的三项检查能够指导尿路感染的诊断方法，在大多数情况下足够了。我们想强调DMSA扫描在诊断未被怀疑的肾脏瘢痕方面的重要性。
