Lavocat M P, Granjon D, Guimpied Y, Dutour N, Allard D, Prevôt N, Dubois F
Department of Paediatrics, CHU Saint Etienne, Hôpital Nord, Saint Etienne, France.
Nucl Med Commun. 1998 Jul;19(7):703-10. doi: 10.1097/00006231-199807000-00013.
At present, 99Tcm-dimercaptosuccinic acid (DMSA) renal scintigraphy is the most sensitive examination for the detection of parenchymal damage during acute pyelonephritis (APN) in children. This prospective study had three aims: (1) to evaluate the medium-term evolution of the scintigraphic abnormalities, to find a prognostic criterion of scintigraphic evolution; (2) to assess the correlation between the severity of early or late scintigraphic damage and selected clinical factors; and (3) to compare the permanent scintigraphic renal scars with intravenous urography (IVU) 2 years after the acute infection. Seventy-four children (mean age 32 months), presenting with a first clinical episode of pyelonephritis and an initial scintigraphic abnormality, were included in the study. Patients with a history of urinary tract infection (UTI), uropathy other than vesico-ureteral reflux (VUR) and a relapse of acute pyelonephritis were excluded. All children underwent control scintigraphy (mean 9 months after APN) and 43 had an IVU (mean 26 months after APN). Fifty-seven children (77%) still have scintigraphic abnormalities of varying severity (7 atrophic kidneys). Initial relative DMSA uptake of less than 45% results in a worse scintigraphic prognosis. The age of the child has no bearing on the severity of the initial renal involvement or on the evolution of the scintigraphic abnormalities. The rapid introduction of antibiotics (< 12 h) significantly improves the scintigraphic prognosis (P < 0.01). The presence of reflux (n = 39) leads to more serious initial damage, but we did not find any effect on later evolution in this study, in which all reflux was low grade in nature. Among the 43 children who had an IVU, 5 showed typical urographic and scintigraphic renal scars in the corresponding region and 38 showed a normal IVU with 28 cases of scintigraphic abnormalities. A DMSA scan is more sensitive than IVU for the detection of renal scarring after a first episode of APN.
目前，99锝-二巯基丁二酸（DMSA）肾闪烁扫描是检测儿童急性肾盂肾炎（APN）期间实质损害最敏感的检查方法。这项前瞻性研究有三个目的：（1）评估闪烁扫描异常的中期演变，寻找闪烁扫描演变的预后标准；（2）评估早期或晚期闪烁扫描损害的严重程度与选定临床因素之间的相关性；（3）在急性感染2年后，将永久性闪烁扫描肾瘢痕与静脉肾盂造影（IVU）进行比较。74名儿童（平均年龄32个月）因首次临床发作肾盂肾炎且初始闪烁扫描异常而被纳入研究。排除有尿路感染（UTI）病史、除膀胱输尿管反流（VUR）以外的泌尿系统疾病以及急性肾盂肾炎复发的患者。所有儿童均接受了对照闪烁扫描（APN后平均9个月），43名儿童接受了IVU检查（APN后平均26个月）。57名儿童（77%）仍有不同程度的闪烁扫描异常（7例肾萎缩）。初始相对DMSA摄取低于45%会导致更差的闪烁扫描预后。儿童年龄与初始肾受累的严重程度或闪烁扫描异常的演变无关。抗生素的快速使用（<12小时）显著改善了闪烁扫描预后（P<0.01）。反流的存在（n = 39）会导致更严重的初始损害，但在本研究中我们未发现对后期演变有任何影响，本研究中所有反流均为轻度。在接受IVU检查的43名儿童中，5名在相应区域显示典型的尿路造影和闪烁扫描肾瘢痕，38名IVU正常但有28例闪烁扫描异常。DMSA扫描在检测首次APN发作后的肾瘢痕方面比IVU更敏感。
