Girardin E, Benador D
Unité de néphrologie métabolisme, HUG hôpital des Enfants, Genève, Suisse.
Arch Pediatr. 1998;5 Suppl 3:285S-289S. doi: 10.1016/s0929-693x(98)80151-6.
Pyelonephritis in children may lead to irreversible renal damage and eventually to arterial hypertension and renal insufficiency. Inflammation plays a central role in the pathogenesis of pyelonephritis. Dimercaptosuccinic acid (DMSA) scintigraphy permits detection of acute renal lesions and renal scars with high sensitivity and specificity. In our experience 60% of patients who had acute renal lesions on DMSA scintigraphy during pyelonephritis develop scars. Young age appears to be not a risk factor, as in our experience 70% of children older than 5 years develop scars compared to 40% for children younger than 1 year. In addition, only 40% of patients who develop scars have vesicoureteral reflux. DMSA scintigraphy may provide answers to important clinical questions: what is the optimal length of treatment of pyelonephritis? Is parenteral treatment necessary? What is the best treatment of vesicoureteral reflux? DMSA scintigraphy permits therapeutical decision-making according to the renal involvement in each of our patients.
儿童肾盂肾炎可能导致不可逆的肾损害，并最终引发动脉高血压和肾功能不全。炎症在肾盂肾炎的发病机制中起核心作用。二巯基丁二酸（DMSA）闪烁扫描术能够以高灵敏度和特异性检测急性肾损伤和肾瘢痕。根据我们的经验，在肾盂肾炎期间DMSA闪烁扫描显示有急性肾损伤的患者中，60%会形成瘢痕。年轻似乎不是一个危险因素，因为根据我们的经验，5岁以上儿童中有70%会形成瘢痕，而1岁以下儿童的这一比例为40%。此外，形成瘢痕的患者中只有40%存在膀胱输尿管反流。DMSA闪烁扫描术可以回答一些重要的临床问题：肾盂肾炎的最佳治疗时长是多少？是否需要肠外治疗？膀胱输尿管反流的最佳治疗方法是什么？DMSA闪烁扫描术能够根据我们每位患者的肾脏受累情况做出治疗决策。
