INVOLVEMENT OF THE RENAL PARENCHYMA IN ACUTE URINARY-TRACT INFECTION - THE CONTRIBUTION OF TC-99M DIMERCAPTOSUCCINIC ACID SCAN

We performed Tc-99m dimercaptosuccinic acid (DMSA) scan and ultrasonography in 146 children during the acute phase of a proven urinary tract infection (UTI). In 99 a micturating cysto-urethrography and in 83 an intravenous urography was also done. The occurrence of fever and increased WBC count, CRP and ESR were also studied. It appeared from this retrospective study that 47% of the kidneys had a cortical or patchy pattern of decreased uptake of Tc-99m DMSA, as compared to 23% with abnormal findings on US. Vesico-ureteral reflux was present in 38% of the kidneys with parenchymal involvement on Tc-99m DMSA scan. Although fever, leucocytosis and elevated CRP and ESR were significantly correlated with abnormal Tc-99m DMSA scan, they were also observed in children without renal parenchymal involvement. Our results suggest that Tc-99m DMSA scan is a sensitive method for the detection of parenchymal involvement during acute UTI. The exact nature of these lesions and their relation with scars need, however, to be defined.