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Diagnostic Value of 99mTc-DMSA Renal Scan for Early Diagnosis of Acute Pyelonephritis in Children with Febrile Urinary Tract Infection

Journal of the Korean Pediatric Society 1996;39(11):1586-1593.
Published online November 15, 1996.
Diagnostic Value of 99mTc-DMSA Renal Scan for Early Diagnosis of Acute Pyelonephritis in Children with Febrile Urinary Tract Infection
Soo Ja Hwang1, Eun Ae Park1, Jeong Wan Seo1, Seung Joo Lee1, Sun Whan Lee2
1Department of Pediatrics, Ewha Womans University, College of Medicine, Seoul, Korea
2Department of Diagnostic Radiology, Ewha Womans University, College of Medicine, Seoul, Korea
발열성 소아 요로 감염에서 급성 신우신염의 조기진단에 대한 99mTc-DMSA 신주사의 진단적 가치
황수자1, 박은애1, 서정완1, 이승주1, 이선화2
1이화여자대학교 의과대학 소아과학교실
2이화여자대학교 의과대학 방사선과학교실
Abstract
Purpose
: For prevention of renal scar, early diagnosis and treatement of acute pyelonephritis are important in children with febrile urinary tract infection. But it has been difficult to differentiate acute pyelonephritis from lower urinary tract infection. We have performed this study to evaluate the diagnostic value of 99mTc-DMSA renal scan and to clarify the relationship among acute pyelonephritis, vesico-ureteral reflux and renal scar.
Methods
: We have studied 100 patients with febrile urinary tract infection, from September, 1993 to June, 1995 at the Pediatric department of Ewha Womans University, Mok-dong hospital. Acute phase reactants, causative organism, renal ultrasound, 99mTc- DMSA renal scan on the acute stage, voiding cystouretherogram after 1-2 weeks of treatement, and follow-up 99mTc-DMSA renal scan were evaluated.
Results
: Ther results are as follows; 1) 57 patients (57%) had defect on 99mTc-DMSA renal scan and diagnosed as acute pyelonephritis. 2) Acute phase reactants, renal ultrasound had low accuracy. 3) VUR was found in 31 (56.1%) of 57 patients with defect which was significantly higher than the 4 (9.3%) of 43 patients without defect on 99mTc-DMSA renal scan. 4) On the follow up 99mTc-DMSA renal scan, 34.8% of defects recorvered, and 65.2% of defects developed renal scar.
Conclusion
: 99mTc-DMSA renal scan is a valuable method for early diagnosis of acute pyelonephritis in children with febrile urinary tract infection. It would contribute to evaluate the relationship between acute pyelonephritis, vesico-ureteral reflux and renal scar.
Key Words: 99mTc-DMSA renal scan, Acute pyelonephritis


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