Korean Journal of Nephrology 2001;20(2):263-269.

원저 : 급성 신우신염과 방광요관역류에서 99mTc-DMSA Scan 의 유용성 (The Usefulness of 99mTc- DMSA Scan in Acute Pyelonephritis and Vesicoureteral Reflux in Children)

박경호(Kyung Ho Park),이경일(Kyung Yil Lee),이형신(Hyung Shin Lee),김상용(Sang Yong Kim),한지환(Ji Whan Han),이익준(Ik Jun Lee),황경태(Kyung Tae Hwang),강시원(Si Won Kwang)

Abstract

During a 4 year period, 118 children(62 boys) below 14 years of age(median 2.9±2.7 years) with symptomatic urinary tract infection were studied by 99mTc-dimercaptosuccinc acid scintigraphy(DMSA scan), ultrasonography and voiding cystoureterography(VCUG). The male to female ratio was 1.1: 1, and 2.4: 1 under 1 year of age, and 0.54: 1 above 1 year age, respectively. Forty-seven patients presented with positive urine cultures and 71 were negative. DMSA scan was performed in 108 patients, and showed abnormalities in 50(46.3%) of them. Renal scars were observed in 24(51.0%) of 47 patients with positive urine culture and 26(42.6%) of 61 patients with negative urine culture, however there was no statistical difference between the two groups. Of the 118 patients VCUG was performed in 92 patients. Vesi- coureteral reflux was found in 29(31.5%) of them. VURs were found in 25(50.0%) of 50 patients with positive and 4(9.6%) of 42 patients with negative findings in DMSA scan. Also, DMSA scan demon-strated scarring in 11(64.7%) of 17 renal units with grade I-II, 12(92.3%) of 13 renal units with grade III, and 9(90.0%) of 10 renal units with grade IV-V. The incidence of positive findings in DMSA scan was higher above grade III. VURs were found in 21 (52.5%) of 40 patients with abnormal findings in ul- trasonography and 8(15.3%) of 52 patients with normal findings. Ultrasonographic findings were abnor- mal in 29(58.0%) of 50 patients with positive findings in DMSA scan and were normal in 47(81.0%) of 58 patients with negative findings. Our study shows that DMSA scan is useful in the diagnosis of acute pyelonephritis and detection of VUR. It is advisable that DMSA scan should be included as an initial evaluation tool for symptomatic urinary tract infection in children and used as a follow-up tool.