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A Renal Size Discrepancy among the Findings of Renal Sonogram in Children with Their First Episode of Pyelonephritis is One of the Useful Parameters to Predict the Presence of Cortical Defects on the Acute DMSA Renal Scan

  • Kwon, Yoowon (Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine) ;
  • Jin, Bo kyeong (Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine) ;
  • Rhie, Seonkyeong (Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine) ;
  • Lee, Jun Ho (Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine)
  • Received : 2018.11.27
  • Accepted : 2019.03.26
  • Published : 2019.04.30

Abstract

Purpose: We investigated whether a renal size discrepancy on a renal sonogram (US) in children with febrile urinary tract infection (UTI) was correlated with the presence of cortical defects on their dimercaptosuccinic acid (DMSA) renal scan. Methods: We examined 911 children who were admitted consecutively to our hospital with their first episode of febrile UTI from March 2001 to September 2014. All enrolled children underwent a US and DMSA scan during admission. According to the US findings, including the renal size discrepancy, data were compared between children with positive and negative DMSA scan results. A positive DMSA scan result was defined as reduced or absent tracer localization and indistinct margins that did not deform the renal contour. Results: Mean renal lengths of the right and left kidneys were larger in children with positive DMSA scan results than in children with negative DMSA scan results ($63.2{\pm}11.3mm$ vs. $58.4{\pm}7.8mm$, P<0.001; $64.9{\pm}11.2mm$ vs. $59.9{\pm}7.9mm$, P<0.001; respectively). A significant difference was observed in both renal lengths between children with positive and negative DMSA scan results ($4.6{\pm}3.8mm$ vs. $3.3{\pm}2.6mm$, P<0.001). A multiple logistic regression analysis, revealed that a small kidney, cortical thinning, and a renal length discrepancy on US findings were significant factors for predicting the presence of cortical defects on an acute DMSA scan [P=0.028, 95% confidence interval (CI) 1.054-2.547; P= 0.004, 95% CI 1.354- 4.810; P<0.001, 95% CI 1.077-1.190, respectively]. Conclusion: In conclusion, a renal size discrepancy on US findings in children with their first episode of febrile UTI was a helpful tool for predicting the presence of cortical defects on an acute DMSA scan.

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References

  1. Lee JH, Kim MK, Park SE. Is a routine voiding cystourethrogram necessary in children after the first febrile urinary tract infection. Acta Paediatr 2012;101:e105-9. https://doi.org/10.1111/j.1651-2227.2011.02507.x
  2. Shaikh N, Spingarn RB, Hum SW. Dimercaptosuccinic acid scan or ultrasound in screening for vesicoureteral reflux among children with urinary tract infections. Cochrane Database Syst Rev. 2016 Jul 5;7:CD010657. Doi:10.1002/14651858.CD010657.pub2.
  3. Leroy S, Gervaix A. Procalcitonin: a key marker in children with urinary tract infection. Adv Urol 2011;2011:397618.doi:10.1155/2011/397618. Epub 2011 Jan 17.
  4. Kim BK, Yim HE, Yoo KH. Plasma neutrophil gelatinase-associated lipocalin: a marker of acute pyelonephritis in children. Pediatr Nephrol 2017;32:477-84. https://doi.org/10.1007/s00467-016-3518-y
  5. Mohkam M, Jahdavi C, Arad B, Moein HR, Tabar RV, Olyaie M, et al. The sensitivity of ultrasonography in detecting renal cortical defects in pyelonephritic patients with or without vesicoureteral reflux. J Ped Nephrol 2013;1:28-31.
  6. Barrt BP, Hall N, Cornford E, Broderick NJ, Somers JM, Rose DH. Improved ultrasound detection of renal scarring in children following urinary tract infection. Clin Radiol 1998;53:747-51. https://doi.org/10.1016/S0009-9260(98)80317-6
  7. Bjorgvinsson E, Majd M, Egglil KD. Diagnosis of acute pyelonephritis in children: Comparison of sonography and 99mTc-DMSA scintigraphy. AJR 1991;157:539-43. https://doi.org/10.2214/ajr.157.3.1651644
  8. Levocat MP, Granjon D, Allard D, Gay C. Imaging of pyelonephritis. Pediatr Radiol 1997;27:159-65. https://doi.org/10.1007/s002470050091
  9. Moorthy I, Wheat D, Gordon I. Ultrasonography in the evaluation of renal scarring using DMSA scan as the gold standard. Pediatr Nephrol 2004;19:153-6. https://doi.org/10.1007/s00467-003-1363-2
  10. Scherz HC, Downs TM, Caesar R. The selective use of dimercaptosuccinic acid renal scans in children with vesicoureteral reflux. J Urol 1994;152:628-31. https://doi.org/10.1016/S0022-5347(17)32668-X