DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20212764

A study to determine risk factors for renal scarring as detected by dimercaptosuccinic acid scan in children with urinary tract infection

Nisha Jacob Arackal Jacob, Seshagiri Koripadu, Harishchandra Venkata Yanamandala

Abstract


Background: The aim of the study was to determine the risk factors for renal scarring detected by DMSA (dimercaptosuccinic acid) scan in children with culture-proven urinary tract infection (UTI).

Methods: A hospital based observational case-control study was conducted from 2018 June to 2020 June in children aged between 1 month to 5 years who underwent a DMSA scan following culture-proven UTI (N=72). Of the children fulfilling the criteria, 43 had renal scarring in the DMSA scan as a case group and the remaining 29 children who had no renal scarring were taken as a control group.

Results: Of the total 72 cases with culture-positive UTI, 59% of patients had renal scarring and the rest and 40% were scar negative. There was no significant difference in the renal scarring observed with respect to age in the two groups. There was significant (p<0.05) the association noted between renal scarring and VUR (vesicoureteric reflux). A significant difference was observed in the renal scarring between the two groups regarding the presence of recurrent UTI (p=0.000). Although most cases (97.7%) had a fever in the DMSA positive group, this was not a significant risk factor for scarring (p>0.05). In DMSA positive group, circumcision was not a significant risk factor for scarring.

Conclusions: VUR and recurrent UTI were significant risk factors for renal scarring in children with culture-proven UTI as detected by DMSA scan. The other risk factors like age, sex, fever, leucocytosis and circumcision were not found to be significant.

 


Keywords


Urinary tract infection, Dimercaptosuccinic acid, Colony forming unit, Voiding cystourethrogram, Micturating cystourethrogram

Full Text:

PDF

References


Smellie J, Edwards D, Hunter N, Normand ICS, Prescod N. Vesicoureteric reflux and renal scarring. Kidney Int. 1975;8:65-72.

Rushton HG, Majd M, Jantausch B, Wiedermann BL, Belman AB. Renal scarring following reflux and nonreflux pyelonephritis in children: evaluation with 99mtechnetiumdimercaptosuccinic acid scintigraphy. J Urol. 1992;147(5):1327-32.

Jakobsson B, Nolstedt L, Svensson L, Soderlundh S, Berg U. 99mTc-Dimercaptosuccinic acid (DMSA) scan in the diagnosis of acute pyelonephritis in children: relation to clinical and radiological findings. Pediatr Nephrol. 1992;6(4):328-34.

Rushton HG. The evaluation of acute pyelonephritis and renal scarring with technetium 99m-dimercaptosuccinic acid renal scintigraphy: evolving concepts and future directions. Pediatr Nephrol. 1997;11(1):108-20.

Ditchfield MR, Campo JFD, Nolan TM, Cook DJ, Grimwood K, Powell HR, et al. Risk factors in the development of early renal cortical defects in children with urinary tract infection. AJR Am J Roentgenol. 1994;162(6):1393-7.

Shaikh N, Ewing AL, Bhatnagar S, Hoberman A. Risk of renal scarring in children with a first urinary tract infection: a systematic review. Pediatrics. 2010;126(6):1084-91.

Majd M, Blask ARN, Markle BM, Shalaby-Rana E, Pohl HG, Park JS, et al. Acute pyelonephritis: comparison of diagnosis with 99mTc DMSA, SPECT, spiral CT, MR imaging and power Doppler US in an experimental pig model. Radiology. 2001;218(1):101-8.

Camacho V, Estorch M, Fraga G, Mena E, Fuertes J, Hernández MA, et al. DMSA study performed during febrile urinary tract infection: a predictor of patient outcome? Eur J Nucl Med Mol Imag. 2004;31(6):862-6.

Lin KY, Chiu NT, Chen MJ, Lai C, Huang J, Wang Y, et al. Acute pyelonephritis and sequelae of renal scar in pediatric first febrile urinary tract infection. Pediatr Nephrol. 2003;18(4):362-5.

Ehsanipour F, Gharouni M, Rafati AH, Ardalan M, Bodaghi N, Otoukesh H. Risk factors of renal scars in children with acute pyelonephritis. Braz J Infect Dis. 2012;16(1):15-8.

Panahi Y, Beiraghdar F, Moharamzad Y, Matinzadeh ZK, Einollahi B. The incidence of urinary tract infections in febrile children during a two-year period in Tehran, Iran. Trop Doc. 2008;38(4):247-9.

Rushton HG, Majd M, Chandra R, Yim D. Evaluation of Tc technetium-dimer-capto-succinicacid renal scans in experimental acute pyelonephritis in piglets. J Urol. 1988:140:1169-74.

Jakobsson B, Svensson L. Transient pyelonephritic changes on 99m technetium dimercaptosuccinic acid scan for at least five months after infection. Acta Paediatr.1997;86(8):803-7.

Lee J, Woo BW, Kim HS. Prognostic factors of renal scarring on follow-up DMSA scan in children with acute pyelonephritis. Childhood Kidney Diseases. 2016;20(2):74-8.

Mir S, Ertan P, Ozkayin N. Risk factors for renal scarring in children with imary vesicoureteral reflux disease. Saudi J Kidney Dis Transpl. 2013;24(1):54-9.

Wiswell TE, Geschke DW. Risks from Circumcision during the first month of life compared with those for uncircumcised boys. Pediatrics. 1989;83(6):1011-5.

Gonzales E, Papazyan JP, Giardin E. Impact of vesicoureteral reflux on the size of renal lesions after an episode of acute pyelonephritis. J Urol. 2005;173(2):571-4.

Piepsz A. Cortical scintigraphy and urinary tract infection in children. Nephrol Dial Transplant. 2002;17(4):560-2.