| Diagnostic Significance of DMSA Renal Scan and C-Reactive Protein in Urinary Tract Infection of Childhood |
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Sung Ho Hong, Hyang Mi Kwon, Hye Lim Jung, Dong Hyuck Kuem |
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Department of Pediatrics, Kangbuk Samsung Hospital, Seoul, Korea |
| 소아 요로감염시 DMSA Renal Scan과 C-Reactive Protein의 진단적 의미 |
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홍성호, 권향미, 정혜림, 금동혁 |
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강북삼성병원 소아과 |
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| Abstract |
Purpose
: Renal scar or reflux nephropathy, known as a major cause of end-stage renal
failure and hypertension in children and young adults, is frequently detected in pediatric urinary
tract infection(UTI) patients at their first infections. So early and accurate diagnosis, and follow
up of renal scar are very important. We performed this study to recognize the importance of
radiologic examinations for detection of renal scar and vesicoureteral reflux(VUR) in pediatric
UTI patients at their first attacks, and to compare the accuracy and usefulness of DMSA renal
scan with renal ultrasonography and IVP in early detection and follow up of renal scar. We
also wanted to find the association of renal scar with VUR detected by VCUG, and increased
C-reactive protein(CRP) level.
Methods
: We studied on 41 pediatric UTI patients without past medical history of UTI, who
were admitted to the Department of Pediatics, Kangbuk Samsung Hospital from May 1993 to
August 1995. On admission a blood sample was taken for the determination of CRP. Renal
ultrasonography and DMSA renal scan were performed within five days after admission. Eight
weeks later, with repeated studies of renal ultrasonography and DMSA renal scan, IVP and
VCUG were also performed for all patients.
Results
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1) The incidence of UTI was most prevalent in infancy group(56%). The ratio of male to
female patients was 4.8:1 under the age of one year, and 1:2 over the age of one year.
2) At admission, 21 of 41 patients(51%) showed renal scars in the DMSA renal scans. At
follow up of DMSA renal scans, 8 weaks later, 7 of 21 initially abnormal cases(33%) became
normal while 14 cases(67%) continued to show renal scars. Twenty initially normal cases
continued to show normal DMSA renal scans at follow up.
3) Renal ultrasonography showed 10 abnormal cases among 41 cases(24%) at admission, and
7 abnormal cases(17%) at follow up. IVP showed 13 abnormal cases among 41 cases(32%).
4) For detection of renal scar, sensitivity and specificity of DMSA renal scan were 95% and
100%, sensitivity and specificity of renal ultrasonography were 45% and 90%, and sensitivity
and specificity of IVP were 59% and 100% retrospectively.
5) VCUG showed reflux in 13 patients among 41 patients(32%). Among 20 patients with
normal DMSA renal scan, only two patients(10%) showed VUR in VCUG, and they were
classified as grade Ⅰ and Ⅱ VUR by International Reflux Study Committee classifications.
Among 21 patients with abnormal by DMSA renal scan, 11 patients(52%) showed VUR in
VCUG, of whom 9 patients were classified as severe reflux above grade Ⅲ.
6) The mean CRP level in the patients with normal DMSA renal scan was 9.6mg/L,
significantly lower than mean CRP level of patients with abnormal DMSA renal scan which was
60.57mg/L(p<0.01).
Conclusion
: For early detection of renal scars and reflux nephropathy, appropriate radiologic
investigations including DMSA renal scan and VCUG should be done to all pediatric UTI
patients at their first attacks. DMSA renal scan seemed to be better radiologic method than
renal ultrasonography and IVP in early detection of renal scar and have association with VUR.
We also found that blood CRP level is easy and useful test for early suspection of upper UTI. |
| Key Words:
UTI, Renal scar, DMSA renal scan, CRP |
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