Childhood Kidney Diseases

Korean Society of Pediatric Nephrology (대한소아신장학회)
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Clinical implications of DMSA Scan in Childhood Acute Pyelonephritis

  • Huh, Sun-Mi (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Park, Bo-Kyoung (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Kang, Hyun-Mi (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Rhim, Jung-Woo (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Suh, Jin-Soon (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Lee, Kyung-Yil (Department of Pediatrics, College of Medicine, The Catholic University of Korea)
  • Received : 2017.09.27
  • Accepted : 2017.10.02
  • Published : 2017.10.30
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Abstract

Purpose: This study aimed to evaluate the relationships between 99mTecnicium-dimercaptosuccinic acid (DMSA) scan findings and clinical parameters including age and fever duration. Methods: The positive rates for abnormal DMSA scans were analyzed according to the age of patients, fever duration prior to admission, and total fever duration. DMSA scan findings were divided into 3 categories: single defect, multifocal defects, and discrepant defects. We evaluated the detection rates of vesicoureteral reflux according to DMSA scan lesions. Results: Among a total 320 cases, 141 (44.1%) had abnormal DMSA scans. The infant group (0-1 year of age) had a shorter total fever duration, and a lower C-reactive protein (CRP) value and DMSA positive rate (39.8% vs. 60.6%, P=0.002) compared to children group (2-15 years of age). Patients with abnormal scans had a longer total fever duration and higher CRP compared to those with normal scans. The positivity rate of abnormal scans did not differ between the patients with a short fever duration prior to admission of ${\leq}2$ days and those with longer fever duration of ${\geq}3$ days. However, patients with longer total fever duration had a higher rate of abnormal DMSA scans (P=0.02). Among cases with a single defect, multifocal defects, and discrepant defects, vesicoureteral reflux was observed in 22.4%, 60% and 70.6% of cases, respectively (P=0.004). Conclusion: Although DMSA scan has limitations in early diagnosis, DMSA scan findings may aid in the prediction of the severity of systemic inflammation and detection of vesicoureteral reflux.

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