THE SIGNIFICANCE OF VESICOURETERAL REFLUX ON KIDNEY DEVELOPMENT ASSESSED BY DIMERCAPTOSUCCINATE RENAL SCINTIGRAPHY

Objective To study the influence of vesicoureteric reflux on kidney parenchyma and renal length, and identify typical distribution patterns by dimercaptosuccinate (DMSA) renal scintigraphy. Patients and methods DMSA renal scintigraphies in 101 children (152 renal units) with vesicoureteric reflux grade 1-5 were reviewed. Results Three main types of pathological DMSA patterns were found: (i) dysplasia; (ii) medial defect; and (iii) pole defects. In children with no history of pyelonephritis a normal distribution pattern was found in 31%, dysplasia in 23%, medial defect in 25%, pole defects in 17% and no typical pattern in 4%. In those with a history of pyelonephritis a normal distribution pattern was found in 28%, dysplasia in 24%, medial defect in 21%, pole defects in 24% and no typical pattern in 3%. A normal pattern was significantly more frequent in kidneys with reflux grade 1-2. Dysplasia was significantly more frequent in kidneys with reflux grade 4-5. In children with no history of pyelonephritis 42% of the renal units had reduced length, 8% with no other sign of pathology. The frequency of reduced kidney length at reflux grade 1-2 did not differ significantly from that at higher grades of reflux. In children with a history of pyelonephritis 52% of the renal units had reduced length, 13% with no other sign of pathology. The frequency of reduced kidney length with a normal DMSA pattern did not differ significantly from that with a pathological pattern. Conclusion The pathological DMSA distribution with vesicoureteric reflux generally conforms to one df three main patterns. Reduced kidney length is frequent even at lower grades of vesicoureteric reflux even in patients with no history of pyelonephritis, and can be the only sign of pathology.