succimer and Urinary-Tract-Infections

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Child, Preschool; Female; Humans; Infant; Male; Radiography; Succimer; Ultrasonography; Urinary Tract Infections

To highlight recent controversies regarding the rationale and effectiveness of imaging and treatment strategies for children who experience a first urinary tract infection.. The yield of renal ultrasound for children who have had a first urinary tract infection is relatively low, and the most commonly identified abnormalities are of unclear clinical significance. If concerned about renal ultrasound abnormalities, clinicians should not be reassured by a normal late trimester prenatal ultrasound because its negative predictive value is not sufficiently high. Vesicoureteral reflux is neither necessary nor sufficient for developing renal scars. Some pyelonephritis and renal scarring may be related to vesicoureteral reflux that is missed by standard voiding cystourethrogram but detectable during positional instillation of contrast cystography. Dimercaptosuccinic acid scans provide important information about presence of pyelonephritis and renal scars, and have high negative predictive value for ruling out high-grade (III-V) vesicoureteral reflux. Antimicrobial prophylaxis may not be effective for preventing recurrent infections and may result in antimicrobial resistance. Endoscopic therapy (Deflux) has demonstrated moderate success in correcting vesicoureteral reflux, but little is known about its impact on recurrent infection and renal scarring.. Debate continues about optimal imaging strategies after first urinary tract infection. More research is needed on the effectiveness of interventions designed to prevent recurrent infections and renal scarring.

Topics: Antibiotic Prophylaxis; Child; Dextrans; Endoscopy; Humans; Hyaluronic Acid; Prostheses and Implants; Succimer; Urinary Tract Infections; Vesico-Ureteral Reflux

Urinary tract infection (UTI) is common in children, particularly in the youngest age groups. There is a risk for progressive deterioration of renal function in these children if aggravating factors such as gross reflux and/or outflow obstruction of the urinary tract are present. In this review the pros and cons of available scintigraphic and radiological imaging techniques for the work-up of these children are presented. Ultrasound can be used in the acute phase to exclude obstruction but can not reliably show transient or permanent parenchymal lesions. The presence of reflux can be established with X-ray or direct nuclide cystography. The X-ray technique gives good morphological information and has a grading system with prognostic relevance. Both techniques are invasive and great care must be taken to keep the radiation burden down with the X-ray technique. Indirect nuclide cystography following a renographic study is non-invasive but has a lower sensitivity than direct techniques. More experience is needed with the indirect technique to evaluate the consequences of its apparently low sensitivity. Urography has a limited place in the acute work-up of urinary tract infection but can be used to look for renal scarring 1-2 years after an acute pyelonephritis. The 99mTc dimercaptosuccinic acid (DMSA) scan can be used during the acute UTI to show pyelonephritic lesions with good accuracy and/or during the follow-up after six months to show permanent lesions. The acute DMSA scan can be omitted. An early treatment is more important than an early scan!

Topics: Child; Diagnostic Imaging; Female; Humans; Male; Radioisotope Renography; Radiopharmaceuticals; Sensitivity and Specificity; Succimer; Technetium Tc 99m Mertiatide; Tomography, Emission-Computed, Single-Photon; Ultrasonography; Urinary Tract Infections

Topics: Child; Child, Preschool; Humans; Infant; Kidney; Kidney Diseases; Organotechnetium Compounds; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections

It is now widely accepted that children with a proven urinary tract infection should undergo some form of diagnostic imaging to assess the presence of, or the potential to develop, renal scarring. The type of investigation which should be performed is controversial. Some centres still perform intravenous urography, others rely on ultrasound alone, while others believe that a 99Tc(m)-dimercaptosuccinic acid (99Tc(m)-DMSA) scan is essential. This review discusses the advantages and disadvantages of these techniques by drawing from the extensive literature currently available. The consensus view is that a DMSA scan is the most sensitive method of detecting renal scarring and of highlighting the kidney at risk of developing scarring. It is hoped that wider early use of DMSA scintigraphy will lead to a fall in the number of children who develop end-stage renal disease.

Topics: Adolescent; Child; Child, Preschool; Humans; Infant; Kidney; Organotechnetium Compounds; Radiation Dosage; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pentetate; Ultrasonography; Urinary Tract Infections

The dimercaptosuccinic acid (DMSA) renal scan is a method for assessing kidney function. Indications for DMSA scanning in children with urinary tract infection (UTI), as well as timing, have changed. Pitfalls in interpreting DMSA scans include: (1) acute pyelonephritis (APN), (2) tubular dysfunction, (3) hypertension, (4) use of captopril in patients with renovascular hypertension and (5) duplex kidneys. Interpretation of DMSA scans in children with UTI vary according to timing and clinical setting. During the course of a febrile UTI a DMSA scan may reveal a normal kidney, APN or a non-functioning, small and/or ectopic kidney. In the absence of UTI (up to 6 months) in children with vesicoureteric reflux a DMSA scan may indicate a normal kidney, renal scarring (reflux nephropathy), occult duplex kidney and allows the progression of scarring and hypertrophy of normal areas of the kidney to be followed anatomically. The DMSA renal scan in now the most reliable test for the diagnosis of APN. The transient abnormalities due to APN can occur in normal or scarred kidneys. Lesions due to reflux nephropathy (defined as a defect in the renal outline or contraction of the whole kidney) are permanent. Intravenous urography reveals renal abnormalities later than the DMSA scan. If abnormalities are seen on a DMSA scan performed during the course of APN it is impossible to predict the outcome: they can progress to permanent scarring or heal completely. An abnormal DMSA scan during a febrile UTI allows the identification of children at risk of developing renal scars. These children should be carefully investigated, maintained on long-term quimioprophylaxis and followed.

Topics: Acute Disease; Animals; Child; Cicatrix; Humans; Injections, Intravenous; Kidney; Kidney Diseases; Organotechnetium Compounds; Pyelonephritis; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections; Urography; Vesico-Ureteral Reflux

In terms of future morbidity and mortality, one of the most important considerations in urinary tract infection is the age of the patient. In adults, only those with complications or illnesses that fail to respond to treatment require investigation to exclude underlying pathology. In contrast, the young are at risk of future hypertensive and renal disease; imaging techniques are therefore of paramount importance to identify those with renal parenchymal disease at an early stage and permit appropriate and adequate treatment. 99mTc-dimercaptosuccinic acid scintigraphy is emerging as the method of choice for this purpose, because it combines high specificity and sensitivity with convenience, repeatability, and acceptable radiation doses. Voiding cystourethrography will also be required in many cases to exclude bladder pathology. New developments include the use of color Doppler ultrasonography and the nuclear magnetic resonance technique of rapid acquisition recall echo urography, both of which may become of value for the detection of scarring.

Topics: Adult; Age Factors; Child; Diagnostic Imaging; Humans; Magnetic Resonance Imaging; Organotechnetium Compounds; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections; Urography

The relationship of urinary tract infection and vesicoureteric reflux with the potential for renal scarring and serious sequelae is well known. Evaluation of the child with urinary tract infection and identification of those at risk for infection are of paramount importance. With early diagnosis and early institution of proper therapy, the likelihood of renal scarring can be significantly reduced, and thus outcome can be improved. This review points to the controversies surrounding the ability to accurately distinguish between upper and lower tract urinary infection, and whether this distinction is important in the care of the child with urinary infection. Vesicoureteric reflux as a risk factor is discussed. Ultrasound examination and voiding cystourethrogram or radionuclide cystogram are generally recommended for evaluating the lower urinary tract of infants and preschool children who have urinary tract infection. The role of dimercaptosuccinic acid scanning in evaluating the upper tract is debated.

Topics: Child, Preschool; Diagnosis, Differential; Humans; Infant; Infant, Newborn; Risk Factors; Sensitivity and Specificity; Succimer; Urinary Tract Infections; Urodynamics; Urography; Vesico-Ureteral Reflux

Renal cortical scintigraphy has been reported to be useful in children for confirmation of the diagnosis of acute pyelonephritis. Subsequent experimental studies have demonstrated that dimercaptosuccinic acid (DMSA) scintigraphy, when compared directly with histopathology, is highly reliable for the detection and localization of parenchymal inflammatory changes associated with acute pyelonephritis. Recent clinical studies of acute pyelonephritis using DMSA scintigraphy reveal that the majority (50 to 91%) of children with febrile urinary tract infections have abnormal DMSA renal scan findings and that the majority of these children do not have demonstrable vesicoureteral reflux. However, when vesicoureteral reflux is present, renal cortical abnormalities are demonstrated by DMSA scintigraphy in 79 to 86% of the kidneys. In children with febrile urinary tract infections routine clinical and laboratory parameters are not reliable in the differentiation of acute pyelonephritis, documented by DMSA renal scan findings, from urinary tract infections without parenchymal involvement. Furthermore, the presence of P-fimbriated Escherichia coli associated with febrile urinary tract infections does not reliably predict those kidneys that have acute parenchymal inflammation demonstrated by DMSA renal scans. DMSA is also the isotope agent of choice for the detection of renal scarring. Clinical studies report greater sensitivity of DMSA renal scintigraphy for the detection of renal scarring when compared with the excretory urogram, particularly in infants and young children. In a recent prospective study of post-pyelonephritic renal scarring in children we found that acquired renal scarring only occurs in sites corresponding exactly to previous areas of acute pyelonephritis demonstrated by DMSA scintigraphy at the time of infection. Furthermore, once acute pyelonephritis occurs, ultimate renal scarring is independent of the presence or absence of vesicoureteral reflux. These findings provide convincing evidence that renal parenchymal infection, rather than vesicoureteral reflux, is the prerequisite for acquired (postnatal) renal scarring. Vesicoureteral reflux as a risk factor for acquired renal scarring is directly related to its role as a risk factor for acute pyelonephritis. We conclude that DMSA scintigraphy is a valid tool for confirming the diagnosis of acute pyelonephritis in children and for identifying kidneys at risk for subsequent renal scarring.

Topics: Acute Disease; Adolescent; Child; Child, Preschool; Cicatrix; Humans; Infant; Infant, Newborn; Kidney Diseases; Pyelonephritis; Radioisotope Renography; Succimer; Urinary Tract Infections

All children with urinary tract infections should be investigated by either excretory urography or abdominal X-ray, ultrasonography and technetium 99m - dimercaptosuccinic acid scintigraphy. Patients in the following categories should also have micturating (voiding) cystourethrography to diagnose or exclude vesico-ureteral reflux: infants aged less than 1 year, children with recurrent (second or subsequent) infections, children with clinically diagnosed acute pyelonephritis and those with a family history of reflux or chronic pyelonephritis. Cystography can safely be omitted in children over 1 year of age with unscarred kidneys and none of the additional risk factors listed. They should be followed for 1-2 years following the first infection for evidence of recurrence.

Topics: Child; Child, Preschool; Humans; Infant; Organotechnetium Compounds; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections; Urography; Vesico-Ureteral Reflux

The role of dimercaptosuccinic acid (DMSA) renal scintigraphy in the first episode of urinary tract infection (UTI) has been the subject of debate for many years. The aim of this study was to evaluate the relationship of voiding cystourethrography (VCUG), renal ultrasonography and DMSA renal scintigraphy and to detect renal parenchymal changes by performing DMSA renal scintigraphy at 6 months after the first episode of UTI.. A prospective study was conducted in 67 hospitalized children (46 boys, 21 girls). Mean age of the patients was 0.97 ± 1.57 years (0.02-7.26 years). All children received VCUG, renal ultrasonography and DMSA renal scintigraphy. DMSA renal scintigraphy was performed at 1 and 6 months after UTI.. Of 67 children, 17 (25.4%), 23 (34.3%) and 20 (29.9%) had vesicoureteral reflux (VUR), abnormal renal ultrasonography and abnormal DMSA renal scintigraphy, respectively. Unilateral hydronephrosis had a significant correlation with VUR at p value 0.024. In renal units, abnormal renal ultrasonography and hydronephrosis had significant correlations with VUR at p values 0.039 and 0.021, respectively. In patients and renal units, hydronephrosis had no significant correlation with abnormal DMSA renal scintigraphy at 1 month after UTI. However, abnormal renal ultrasonography and VUR had significant correlations with abnormal DMSA renal scintigraphy at p values 0.022 and < 0.001 in patients and at p values 0.024 and < 0.001 in renal units, respectively. Both in patients and renal units, VUR (Grade I-III) had no significant correlation with abnormal DMSA renal scintigraphy. However, severe VUR (Grade IV-V) had significant correlations with abnormal DMSA renal scintigraphy at p values < 0.001 and < 0.001, respectively. Seventeen patients underwent DMSA renal scintigraphy at 6 months after UTI. In addition, 15 (88.2%) developed persistent renal scarring.. Abnormal renal ultrasonography and severe VUR identify renal parenchymal changes. DMSA renal scintigraphy in the first episode of UTI should be carried out in those patients. Abnormal DMSA renal scintigraphy at 1 month after UTI has a tendency to persist.

Topics: Child; Child, Preschool; Female; Humans; Infant; Kidney; Male; Radionuclide Imaging; Succimer; Time Factors; Ultrasonography; Urinary Tract Infections

The aim of this study was to compare, in children with acute pyelonephritis, the efficacy of 7 days' (group A) and 3 days' (group B) intravenous antibiotics, both followed by an oral treatment. Children were randomized after 3 days of intravenous treatment. Technetium-99m dimercaptosuccinic acid (DMSA) scintigraphy was performed within the first days after admission and repeated 6 months later. Total or partial persistence of renal abnormalities on the 6-month DMSA scintigraphy was used as the endpoint of the study. Among the 92 children included in the study, 87 were followed for at least 6 months (43 in group A and 44 in group B) and were eligible for analysis. Late DMSA was abnormal in 9 kidneys of group A and 12 kidneys of group B, representing respectively 24% and 44% of kidneys with abnormalities on the initial DMSA (difference statistically not significant). When the patients were stratified according to the delay of treatment, the percentage of patients with sequelae in group A was comparable, whether the delay was less or more than 1 week. In group B, the percentage of patients with sequelae was significantly higher (P<0.01) when the delay was more than 1 week.

Topics: Acute Disease; Administration, Oral; Anti-Bacterial Agents; Child, Preschool; Hospitalization; Humans; Infant; Injections, Intravenous; Kidney; Prospective Studies; Pyelonephritis; Radiography; Radionuclide Imaging; Recurrence; Succimer; Time Factors; Treatment Outcome; Urinary Tract Infections

The results of serial dimercaptosuccinic acid (DMSA) imaging over 5 years are reported in 287 children with severe vesico-ureteral reflux entered into the European Branch of the International Reflux Study in Children. The children were randomly allocated to medical (n=147) or surgical (n=140) management and DMSA studies were performed during the follow up period at least 6 months after any urinary tract infection. Abnormal images were classified into four types: (1) large polar hypodensity with normal renal outline; (2) peripheral photon deficient defect(s) in a non-deformed kidney; (3) small renal image with normal contour; and (4) peripheral defect(s) with resultant irregularity of the renal outline. The DMSA findings were abnormal at entry in 235 (82%) with no difference in incidence or severity between the two treatment groups. During follow up, deterioration was observed in 25 medically and 23 surgically treated patients and comprised image deterioration alone in 17, image deterioration with corresponding reduction in differential function in 16 and reduction in relative function without image change in 15, with similar distribution between the two treatment groups. Deterioration was more frequent in children entering the study under the age of 2 years and in those with grade IV rather than grade III reflux. These findings, showing no difference in outcome between children managed surgically or medically, are consistent with the radiological results already published.. In the International Reflux Study the DMSA scintigraphic data showed no difference in outcome between children managed surgically or medically.

Topics: Child; Child, Preschool; Female; Humans; Kidney; Male; Radionuclide Imaging; Recurrence; Succimer; Urinary Tract Infections; Vesico-Ureteral Reflux

A system for defining renal scarring on ultrasound is proposed and compared with DMSA scintigraphy. Renal scarring was assessed with ultrasound in children following urinary tract infection (UTI) using the following criteria: (1) proximity of sinus echoes to cortical surface; (2) loss of pyramids; (3) irregularity of outline; (4) loss of definition of capsular echo; and (5) calyceal dilatation. Three hundred and thirty-nine consecutive ultrasound scans (US) and DMSA scintigrams, comprising 648 kidneys, were performed and reported blindly and the results were compared. Using DMSA scintigraphy as the gold standard, ultrasound had a positive predictive value of 93% and a negative predictive value of 95%. Ultrasound disagreed with DMSA scintigraphy in 5.2% of kidneys. On review of the cases of disagreement where arbitration was possible by comparison with other imaging, ultrasound was incorrect in 10 kidneys and DMSA was incorrect in 13. We conclude that the sensitivity in the ultrasound detection of renal scarring can be greatly improved using this method. If no scars were detected at ultrasound an alternative explanation for an abnormal DMSA scintigram should be sought.

Topics: Adolescent; Age Factors; Child; Child, Preschool; Cicatrix; False Negative Reactions; False Positive Reactions; Female; Humans; Infant; Infant, Newborn; Kidney Diseases; Male; Predictive Value of Tests; Radionuclide Imaging; Sensitivity and Specificity; Succimer; Ultrasonography; Urinary Tract Infections

Topics: Child; Fever; Humans; Infant; Kidney; Radiopharmaceuticals; Succimer; Urinary Tract Infections

Hydronephrosis, a condition that is mostly congenital, is considered as the most common type of pediatric urinary tract disorder. The aim of this study was the evaluation of the prognosis and outcomes of hydronephrosis in cases of congenital hydronephrosis.. In a cross-sectional study, run in a tertiary clinic of pediatric nephrology, from 2015 to 2020, patients with fetal hydronephrosis were selected. Ultrasonography, urinalysis and kidney function tests were ordered for all patients and in the presence of hydronephrosis, repeated ultrasonography, voiding cystourethrography and dimercaptosuccinic acid scan were performed. In cases with evidence of obstruction, a diethylenetriamine pentaacetic acid scan and relative surgical procedures were performed.. Among 141 cases, mean age was 8 ± 1.4 years and 80.9% were male. Partial or complete obstruction in the right and left kidney was found in 16.3 and 24.8% of patients, respectively. The degree of hydronephrosis was mild in 46.1%, moderate in 39%, and severe in 9.2% of the patients. At the last follow-up period, hydronephrosis recovered in 46% of the patients, while 54% experienced persistence or exacerbation of the disease. Meanwhile, 7.1% of patients showed neurogenic bladder, 19.1% urinary tract infection and 22.7% urinary stones.. Our study revealed that fetal hydronephrosis ends in complete recovery following birth in 46% of the cases. However, in cases experiencing persistent or exacerbating hydronephrosis, optimized treatment and/or surgical intervention are required.  DOI: 10.52547/ijkd.6516.

Topics: Child; Cross-Sectional Studies; Female; Humans; Hydronephrosis; Male; Pentetic Acid; Pregnancy; Succimer; Ultrasonography, Prenatal; Urinary Tract Infections

Urinary tract infections (UTIs) represent a common febrile illness in infancy. The study compared two UTI guidelines in terms of number of imaging studies, presence of parenchymal damage and radiation exposure in patients with the first febrile UTI between 2 and 24 months of age.. The results of Tepecik UTI Guideline-1 used until 2012 (Group 1, n = 105) were retrospectively compared with Tepecik UTI Guideline-2 (Group 2) used after 2013. In Group 1, urinary tract ultrasonography (US), dimercaptosuccinic acid (DMSA) and voiding cystourethrography (VCUG) were made in all patients. In Group 2, if the US result was abnormal, patients were evaluated with VCUG and DMSA. If the US was normal, only DMSA was performed. If the DMSA was abnormal, the VCUG was undergone (n: 43, 40.9%).. The abnormal VCUG detection rate was 69.2% in Group 1 and 30.8% in Group 2 (p = 0.09). Sensitivity and specificity of US in the diagnosis of vesicoureteral reflux (VUR) was 15.9% and 96.7% in Group 1 and 61.5% and 70.5% in Group 2, respectively. Abnormal DMSA findings were observed among 33.3% (Groups 1) and 66.7% (Groups 2) subjects, respectively (p > 0.05). The median radiation exposure (500 mrem) of patients in Group 1 was statistically significantly higher than those in Group 2 (200 mrem) (p < 0.001).. The VCUG should not be the first examination to be considered in such patients. We think that Tepecik UTI Guideline-2 reduces unnecessary invasive procedure and radiation exposure and not missed VUR in the management of children with UTI at 2-24 months. Needs prospective follow-up studies before considering this recommendation.

Topics: Child; Humans; Infant; Prospective Studies; Retrospective Studies; Succimer; Urinary Tract Infections; Vesico-Ureteral Reflux

Positioning the Instillation of Contrast cystography (PICc) is used to identify occult vesicoureteric reflux (VUR) in patients with recurrent urinary tract infections (UTI) despite optimized bladder and bowel function and without VUR demonstrated on conventional imaging.. To determine the incidence of finding occult VUR in such patients usingPICc and the benefit, if any, of treating it. We also assessed if this was influenced by abnormalities on the pre-operative DMSA.. This was a retrospective review of PICc in our hospital between 2016 and 2018 and involved three paediatric urologists. The primary indication for PICc was two or more culture proven UTIs despite optimized bladder and bowel function and no reflux on voiding cystourethrography (VCUG) or indirect radionuclide cystography (I-RNC). All children had a preoperative DMSA scan to document any abnormalities. PICc was performed in a standardized way to each ureteric orifice. If occult reflux was found, it was treated concomitantly by cystoscopic injection of Deflux®. To assess the influence of the pre-operative DMSA status, the cohort was subdivided into two groups based on the DMSA scan: Group 1-abnormal DMSA, Group 2-normal DMSA. The median follow-up was 26 months (range 3-39 months).. PICc was performed in 25 patients [23 females and 2 males; median age: 7 years (range 2-16 years; IQR = 4)]; 17 from Group 1 and 8 from Group 2. Occult VUR was identified in 22 patients (88%); 15/17 (88.2%) in Group 1 and 7/8 (87.5%) in Group 2 (p = 0.9). After cystoscopic treatment, 21/25 (84%) became infection free and this was not influenced by the preoperative DMSA status (p = 0.6). Fig 1.. In this challenging group of patients, looking for and treating occult reflux appears to be clinically useful and beneficial. The ability to test and treat at the same sitting is an added advantage of PICc. The DMSA results did not influence the diagnostic or therapeutic aspect of the process. Our results concur with other published literature.. There is a high incidence of finding occult reflux using PICc in this cohort of patients. Concomitant cystoscopic treatment led to 84% of children becoming infection free on follow up. Abnormalities on DMSA did not influence either the likelihood of finding occult reflux or the likelihood of successful treatment.

Topics: Adolescent; Child; Child, Preschool; Cystography; Female; Humans; Infant; Male; Retrospective Studies; Succimer; Urinary Tract Infections; Vesico-Ureteral Reflux

There is no general agreement among paediatric urologists on how infants with spina bifida (SB) should be investigated after birth. Recently the EUA/ESPU guidelines have been published recommending a baseline DMSA scan in the first year of life and a Voiding Cystourethrogram (VCUG) or Videourodynamic (VUD) between the second and third month of life.. The aim of this study was to evaluate the outcome of renal investigations in the first year of life in infants with SB to verify if an early DMSA scan is indicated in the management of this group of patients.. All renal imaging, Renal and Bladder Ultrasound (RBUS), VCUGs, VUDs and DMSA were reviewed by two independent assessors to evaluate outcome.. Seventy patients with spina bifida (40 girls) were enrolled between June 2015 and February 2020. An early VUD detected vesico-ureteral reflux (VUR) in 8/49 (16%) of patients. An early VUD also gave additional information on detrusor under or over activity, bladder trabeculation, end filling detrusor pressure (EFDP) and sphincteric incompetence. DMSA scan detected renal scarring in 4/68 (6%) patients. Three of these 4 patients had significant history of febrile UTIs while the fourth patient had grade 2 left sided VUR.. The initial assessment of a newborn with myelodysplasia includes a Renal and Bladder Ultrasound during birth hospitalization. This study confirms the recently published EUA/ESPU guidelines on the management of neurogenic bladder in children and adolescents, which recommend a VUD or VCUG & Cystomanometry with Electromyogram (CMG) (if VUD not available) in the first 6-12 weeks of life. A selective approach to DMSA scan only in infants with SB who either had a febrile UTI or vesico-ureteric reflux would not have missed any scarring or dysplasia and would have saved 58 unnecessary nuclear scans.

Topics: Adolescent; Child; Female; Humans; Infant; Infant, Newborn; Kidney; Spinal Dysraphism; Succimer; Urinary Tract Infections; Vesico-Ureteral Reflux

The objective of our study was to evaluate the performance of renal contrast-enhanced ultrasound (CEUS) against the 99m-labeled dimercaptosuccinic acid (DMSA) scan and computed tomography (CT) in children for the diagnosis of acute pyelonephritis. We included children who underwent both renal CEUS and the DMSA scan or CT. A total of 33 children (21 males and 12 females, mean age 26 ± 36 months) were included. Using the DMSA scan as the reference standard, the sensitivity, specificity, positive predictive value, and negative predictive value of CEUS was 86.8%, 71.4%, 80.5%, and 80.0%, respectively. When CT was used as the reference standard, the sensitivity, specificity, positive predictive value, and negative predictive value of CEUS was 87.5%, 80.0%, 87.5%, and 80.0%, respectively. The diagnostic accuracy of CEUS for the diagnosis of acute pyelonephritis was 80.3% and 84.6% compared to the DMSA scan and CT, respectively. Inter-observer (kappa = 0.54) and intra-observer agreement (kappa = 0.59) for renal CEUS was moderate. In conclusion, CEUS had good diagnostic accuracy for diagnosing acute pyelonephritis with moderate inter- and intra-observer agreement. As CEUS does not require radiation or sedation, it could play an important role in the future when diagnosing acute pyelonephritis in children.

Topics: Adolescent; Child; Child, Preschool; Female; Humans; Infant; Kidney; Male; Pyelonephritis; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Succimer; Tomography, X-Ray Computed; Ultrasonography; Urinary Tract Infections

To determine the performance of late dimercaptosuccinic acid (DMSA) renal scans in identifying high-grade (III-V) vesicoureteral reflux (VUR) in children aged over 3 y with a febrile urinary tract infection (fUTI) history that has not been timely investigated.. In this retrospective study of diagnostic accuracy, the clinical records of children aged between 3 and 18 y with fUTI history evaluated consecutively at Nephrology Unit of Hospital General de Niños Pedro de Elizalde, Argentina between 2006 and 2016 were reviewed. Patients with previously diagnosed renal or urinary tract abnormalities or who underwent previous postnatal genitourinary imaging were excluded. Only those assessed by renal and bladder ultrasound (RBUS), voiding cystourethrogram (VCUG) and late 6-mo DMSA scan were analyzed. The ability of the scintigraphy in identifying high-grade VUR was determined by comparing its findings with those of VCUG.. In 122 children (median age 5.37 y, 88.5% girls) RBUS was abnormal in 53 (43.4%) and 58 (47.5%) had VUR (30 of high-grade). Abnormal DMSA scan findings (70 patients, 57.4%) were associated with all grade (p = 0.00001) and with high-grade VUR (p = 0.00001). Sensitivity, specificity, negative (NPV) and positive (PPV) predictive values of late DMSA scans for all grades VUR were 93.1%, 75%, 92.3% and 77.1%, respectively. Only 4 patients with low-grade VUR had normal scans. For high-grade VUR, sensitivity and NPV reached 100%.. In older children, the normal late DMSA scan predicted the absence of high-grade VUR, obviating the need for a VCUG. This approach could be a possible strategy for children not studied at acute infection time.

Topics: Adolescent; Child; Child, Preschool; Female; Humans; Kidney; Male; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Succimer; Ultrasonography; Urinary Bladder; Urinary Tract Infections; Vesico-Ureteral Reflux

The strong association between kidney and urinary tract anomalies and childhood urinary tract infection (UTI) often leads to imaging tests being performed. -Objective: To describe the epidemiology, characteristics, and imaging findings in Thai children with UTI and compare results between boys and girls.. We retrospectively reviewed the medical records of children with UTI aged < 15 years. Demographic characteristics and findings of investigations are presented.. One hundred seventy-eight boys and 170 girls with 432 UTI episodes were identified. The median (interquartile range) age at presentation was 1.4 (0.6-3.4) years, 1.0 for boys and 2.1 for girls (p < 0.001). Renal ultrasound, voiding cystourethrogram and 99mTc dimercaptosuccinic acid (DMSA) renal scans were performed in 273, 223 and 113 children, respectively. Overall, 283 children (81.3%) had at least one imaging study done and anomalies of the kidney and urinary tract were detected in 158 (45.4%). Primary vesicoureteral reflux was detected in 73 (32.7%) children. The remaining abnormalities were hydronephrosis (n = 54). DMSA scans detected 54 children with dysplastic or scarred kidneys.. First UTI in a group of Thai children occurred in approximately equal proportion in boys and girls but boys were younger at diagnosis. Kidney and urinary tract anomalies were detected in half of the children.

Topics: Child; Child, Preschool; Cystography; Escherichia coli Infections; Female; Humans; Infant; Infant, Newborn; Kidney; Male; Retrospective Studies; Sex Factors; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Tertiary Healthcare; Thailand; Ultrasonography; Urinary Tract; Urinary Tract Infections; Vesico-Ureteral Reflux

Topics: Humans; Role; Succimer; Tomography, X-Ray Computed; Urinary Tract Infections; Vesico-Ureteral Reflux

Delta neutrophil index (DNI) is the fraction of circulating immature granulocytes, which reflects severe bacterial infections and septic condition but has not been studied in urinary tract infection (UTI). Here, we evaluated the value of DNI in predicting acute pyelonephritis (APN) or vesicoureteral reflux (VUR) using the data of 288 patients. Conventional inflammatory markers (white blood cell [WBC] count, erythrocyte sedimentation rate [ESR], C-reactive protein [CRP]), and DNI were measured. WBC, CRP, ESR and DNI were higher in APN than in lower UTI (p < 0.01). Multiple logistic-regression analyses showed that DNI was a predictive factor for areas of lack of uptake on dimercaptosuccinic acid (DMSA) scans (P < 0.01). The area under the receiver operating characteristic (AUC) was also high for DNI (0.622, 95% CI 0.558-0.687, P < 0.01) as well as for CRP (0.731, 95% CI 0.673-0.789, P < 0.01) for the prediction of DMSA defects. DNI demonstrated the highest area under the ROC curve for diagnosis of VUR (0.620, 95% CI 0.542-0.698, P < 0.01). To the best of our knowledge, this is a first study demonstrating that DNI can be used as a diagnostic marker to distinguish APN from lower UTI and function as a diagnostic marker indicative of VUR compared to other conventional markers.

Topics: Area Under Curve; Blood Sedimentation; C-Reactive Protein; Female; Fever; Humans; Infant; Logistic Models; Male; Neutrophils; Reflex; ROC Curve; Succimer; Urinary Tract Infections

This study was conducted to determine the relationship between overweight/obesity and UTI in children. A comparison was made, in terms of overweight and obesity, between 135 children with UTI (case group) and 135 healthy children (control group). UTI was diagnosed through urine culture. Dimercaptosuccinic acid renal scanning (DMSA) was also used to distinguish between lower UTI and acute pyelonephritis. Overweight and obesity were determined based on standard body mass index (BMI) curves. There were 12 (8.8%) overweight and 26 (19.2%) obese children in the case group. Four (3.0%) overweight and five (3.7%) obese children were found in the control group. There was a significant difference between the two groups regarding overweight and obesity frequencies. However, no such difference existed between children with cystitis and acute pyelonephritis. This study showed a significant relationship between overweight/obesity and UTI. Therefore, overweight and obesity may play a role in the pathogenesis of UTI in children.

Topics: Body Mass Index; Case-Control Studies; Child; Child, Preschool; Female; Hospitals, University; Humans; Infant; Iran; Male; Obesity; Overweight; Pyelonephritis; Radiopharmaceuticals; Risk Factors; Succimer; Ultrasonography; Urinary Tract Infections

To determine use of early Tc-99m dimercaptosuccinic acid scintigraphy in screening for vesicoureteral reflux following first febrile urinary tract infection.. 43 children (1 mo-5 yr) with first febrile urinary tract infection underwent micturating cystourethrography, abdominal sonogram and early dimercaptosuccinic acid scintigraphy.. Early dimercaptosuccinic acid scintigraphy had 72% sensitivity and 76% specificity for vesicoureteral reflux. For dilating vesicoureteral reflux, sensitivity and specificity were 100% and 75%, respectively.. Early dimercaptosuccinic acid scintigraphy has the potential to replace micturating cystourethrography in initial evaluation of febrile urinary tract infection.

Topics: Child, Preschool; Fever; Humans; Infant; Kidney; Radionuclide Imaging; Sensitivity and Specificity; Succimer; Urinary Tract Infections; Vesico-Ureteral Reflux

To clarify the impact of the updated American Academy of Pediatrics guidelines for the evaluation of children presenting with initial febrile urinary tract infection (UTI) on the diagnosis of vesicoureteral reflux (VUR) in children with normal renal sonograms.. Children with VUR followed between 2002 and 2004 were evaluated using criteria specified in the AAP guidelines. A total of 49 children (42 girls) who were 2-24 months of age at diagnosis of VUR made following initial febrile UTI were included.. 40.8% of ultrasounds were abnormal. While children with abnormal ultrasounds were more likely to have scintigraphic evidence of renal damage than children with normal ultrasounds (50% vs 17%, p = 0.026), one third of the children with abnormal renal scans had normal RBUS. There was no statistically significant difference in diagnosis of grade 3 or higher VUR between groups (p = 0.136).. Most children in this series would not have been diagnosed with VUR after initial febrile UTI. More worrisome, 17.2% of children with normal ultrasound had renal injury identified on renal scanning, and 62.1% had grade 3 or higher VUR. These findings reinforce concerns that the new guidelines may miss or delay diagnosis of clinically significant VUR.

Topics: Diagnostic Techniques, Urological; Female; Humans; Infant; Kidney; Male; Practice Guidelines as Topic; Succimer; Ultrasonography; Urinary Tract Infections; Vesico-Ureteral Reflux

To evaluate the role of renal ultrasonography (USG) in predicting vesicoureteral reflux (VUR) in children with mild renal scarring determined by dimercaptosuccinic acid scintigraphy performed after attack of urinary tract infections (UTI).. Dimercaptosuccinic acid scintigraphy, voiding cystourethrography (VCUG), and renal USG findings were evaluated retrospectively in children with UTI. Each kidney was evaluated as a separate renal unit (RU). RUs with severe scarring were excluded from the study. RUs having mild scarring with and without abnormal USG findings (group 1 and group 2, respectively) were compared in terms of the presence of VUR.. There were a total of 228 patients (70 men, mean age 47.06 ± 44.14 months) and 456 RUs. Of the 185 RUs with mild scarring, 55 had abnormal USG findings (group 1), whereas 130 had normal USG findings (group 2). The rates of VUR and severe VUR (≥grade 4) were higher in group 1 compared with group 2 (69% vs 43%, P = .001 and 35% vs 7% respectively, P <.001). The sensitivity, specificity, positive predictive value, negative predictive value, and odds ratio of USG findings in predicting VUR in RU with mild scarring were 68%, 80%, 38%, 93%, and 8.2, respectively.. Normal renal USG findings exclude a diagnosis of high-grade VUR to a large extend in children with UTI and mild renal scarring. Refraining from invasive VCUG might be a reasonable approach in these patients provided that no other predisposing factors for UTI and/or renal scarring present.

Topics: Child; Child, Preschool; Cicatrix; Female; Fever; Humans; Infant; Kidney; Male; Pyelonephritis; Radionuclide Imaging; Retrospective Studies; Succimer; Ultrasonography; Urinary Tract Infections; Vesico-Ureteral Reflux

The purpose of this study was to evaluate the applicability of the National Institute for Health and Clinical Excellence (NICE) guidelines for imaging studies in children under the age of three with first urinary tract infection (UTI).. In our cohort of 112 patients, we gathered data regarding the occurrence of indications for ultrasonography (US) and voiding cystourethrography (VCUG) according to the NICE guidelines, dimercaptosuccinic acid (DMSA) scintigraphy examinations, UTI recurrence, antimicrobial prophylaxis (AMP), anti-reflux procedures, and other urological procedures.. If the NICE guidelines had been applied, 13 of the 25 patients (52 %) with vesicoureteral reflux (VUR), including 6 of the 12 patients (50 %) with dilating VUR and 3 of the 4 patients who underwent endoscopic anti-reflux treatment, would have been missed, and a negative VCUG would have been avoided in 25 of the 42 patients (60 %) with no VUR. None of the missed diagnoses occurred in the younger boys' group.. Based on these preliminary analyses, we feel that the NICE guidelines for imaging studies in children under 3 years old with UTI may be applicable to clinical use only in boys under 6 months of age. For other patients the guidelines were unsuccessful.

Topics: Child, Preschool; Cohort Studies; Feasibility Studies; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Kidney; Male; Practice Guidelines as Topic; Radiography; Radionuclide Imaging; Succimer; Ultrasonography; Urethra; Urinary Bladder; Urinary Tract; Urinary Tract Infections; Urination; Vesico-Ureteral Reflux

The prevalence of vesicoureteral reflux (VUR) in hypospadic patients is reportedly higher than in healthy children. We investigated the prevalence and the clinical course of VUR in hypospadic patients.. We carried out intraoperative cystography to detect VUR in 338 patients who underwent hypospadias repair. Age, severity of hypospadias and the presence of VUR were investigated. A dimercaptosuccinic acid renal scan and follow-up voiding cystourethrography (VCUG) were carried out if VUR was detected.. VUR was detected in 41 patients (12.1%). Of 156 patients who were younger than 1 year-of-age, 34 (21.8%) were found to have VUR. The prevalence of VUR was significantly higher in patients younger than 1year (P<0.001), but was not associated with hypospadias type (P=0.212). The reflux grades were I, II and III in 6, 52 and 1 renal units, respectively. Renal scarring was shown in one of 36 patients. Follow-up VCUG was carried out in 30 patients at a mean of 14.28±3.89months, and reflux resolved in 27 and improved from grade II to grade I in three patients.. Although its prevalence is higher in hypospadic children than in healthy children, it is not necessary to screen for VUR in hypospadic patients, because it is likely to be low-grade and to resolve in most cases.

Topics: Chelating Agents; Cicatrix; Follow-Up Studies; Humans; Hypospadias; Infant; Male; Prevalence; Succimer; Treatment Outcome; Unnecessary Procedures; Urinary Tract Infections; Urination; Urography; Vesico-Ureteral Reflux

We report a cross-sectional study performed to evaluate the imaging findings of 40 children, aged one month to five years (16.65 ± 14.97 months), who presented with protracted fever of more than 48 hours due to urinary tract infection (UTI). About 85% of the patients had positive Tc99-Dimercaptosuccinic acid (DMSA) scan and 58% had vesicoureteral reflux (VUR). Kidney sonography aided in the diagnosis and treatment in 10% of the patients. Age, sex, presence or laterality of VUR did not contribute to defective DMSA scan (pyelonephritis) (P > 0.05). Delayed diagnosis and treatment of febrile UTI is associated with a high incidence of positive findings of DMSA scan irrespective of age, sex or presence/absence of VUR. In mild VUR, the DMSA scan may be normal while in patients with moderate and severe VUR the DMSA scan is almost always abnormal. Thus, our study shows that a normal DMSA scan can help in ruling out moderate to severe forms of VUR and that cystography remains an excellent and standard tool for the diagnosis of VUR.

Topics: Chelating Agents; Child, Preschool; Cross-Sectional Studies; Female; Fever; Humans; Infant; Kidney; Male; Prognosis; Radionuclide Imaging; Succimer; Urinary Tract Infections; Vesico-Ureteral Reflux

Topics: Child; Diagnostic Techniques, Urological; Fever; Humans; Succimer; Urinary Tract Infections; Vesico-Ureteral Reflux

We conducted a retrospective multicenter review to estimate the prevalence of urological abnormalities in Chinese children with first febrile urinary tract infection (UTI) and to evaluate the selective imaging strategy recommended by the NICE guideline for detecting underlying abnormalities. Atypical UTI was defined as in the NICE UTI guideline. Overall, 576 boys and 244 girls aged below 24 months were reviewed. All underwent ultrasound (US) and micturating cystourethrogram (MCUG) and 612 underwent DMSA scans. US was abnormal in 73 (8.9%) and vesicoureteral reflux was shown in 195 patients (23.8%). A total of 126 patients were considered to have remediable urological abnormalities requiring additional surgical or medical interventions. The NICE guideline yielded excellent negative predictive values (NPV) of 100-94.4% in girls but 91% in boys. If all boys underwent US and DMSA and only those with atypical UTI or abnormal US or DMSA proceeded to MCUG, then the NPV increased to 95.2% and 97.4% for boys aged below and above 6 months, respectively. These revised strategies would substantially save invasive studies-DMSA and MCUG in 27 and 74% of girls aged below and above 6 months, respectively, or MCUG in 23 and 59% of boys aged below and above 6 months, respectively.

Topics: Asian People; Child; Diagnostic Imaging; Female; Fever; Humans; Infant; Male; Practice Guidelines as Topic; Predictive Value of Tests; Radiopharmaceuticals; Retrospective Studies; Succimer; Urinary Tract Infections

The aim of this study was to evaluate the usefulness of procalcitonin (PCT) as a marker of renal scars in infants and young children with a first episode of acute pyelonephritis. Children aged 7 days to 36 months admitted for first febrile urinary tract infection (UTI) to a pediatric emergency department were prospectively enrolled. The PCT concentration was determined at admission. Acute (99m)Tc-dimercaptosuccinic acid (DMSA) scintigraphy was performed within 7 days of admission and repeated 12 months later when abnormal findings were obtained on the first scan. Of the 72 children enrolled in the study, 52 showed signs of acute pyelonephritis (APN) on the first DMSA scan. A follow-up scintigraphy at the 12-month follow-up performed on 41 patients revealed that 14 (34%) patients had developed renal scars; these patients also presented significantly higher PCT values than those without permanent renal lesions [2.3 (interquartile range 1-11.6) vs. 0.5 (0.2-1.4) ng/mL; p = 0.007]. A comparison of the PCT concentration in patients with febrile UTI without renal involvement, with APN without scar development and with APN with subsequent renal scarring revealed a significant increasing trend (p = 0.006, Kruskal-Wallis test). The area under the ROC curve for scar prediction was 0.74 (95% confidence interval 0.61-0.85), with an optimum statistical cut-off value of 1 ng/mL (sensitivity 78.6%; specificity 63.8%). Based on these results, we suggest that serum PCT concentration at admission is a useful predictive tool of renal scarring in infants and young children with acute pyelonephritis.

Topics: Acute Disease; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Child, Preschool; Cicatrix; Cohort Studies; Female; Fever; Follow-Up Studies; Humans; Infant; Infant, Newborn; Kidney; Male; Predictive Value of Tests; Prospective Studies; Protein Precursors; Pyelonephritis; Radionuclide Imaging; ROC Curve; Sensitivity and Specificity; Succimer; Time Factors; Ultrasonography; Urinary Tract Infections

In this descriptive study of radionuclide cystography, time-activity curves were generated from renal pelves with reflux and evaluated to reveal the physiology of the reflux. The generated new parameters were also evaluated for any correlation with the frequency of urinary tract infections and renal scarring.. Thirty-two children with reflux to the renal pelvis (36 refluxing units) were included. Regions of interest were drawn on the pelves and bladder, and time-activity curves were generated. The first reflux phase, the bladder volume at first reflux, and the bladder volume at maximal reflux were defined, and reflux percentages were calculated. Dimercaptosuccinic acid (DMSA) scintigraphy findings and urinary tract infections were used for correlation.. New curves from the renal pelvis during bladder filling and bladder emptying were generated and their patterns classified. Episodic reflux to the pelvis was observed on time-activity curves, which demonstrated 4 different emptying patterns during voiding. These patterns were described in detail. Visually, residual activity was present in the renal pelves in 58.8% of patients. The mean number of urinary tract infections per year was 1.07 (range, 0-4; SD, 0.88). The DMSA findings were normal in 57.1% of the patients.. We obtained and categorized some new time-activity curve patterns from renal pelves with reflux on radionuclide cystography. Discussing these patterns may help physicians understand the physiology of the reflux and the relationship between infections and reflux.

Topics: Adolescent; Child; Child, Preschool; Cicatrix; Female; Humans; Infant; Kidney Pelvis; Male; Radionuclide Imaging; Retrospective Studies; Succimer; Time Factors; Urinary Bladder; Urinary Tract Infections; Vesico-Ureteral Reflux

Topics: Child; Cystoscopy; Diagnosis, Differential; Humans; Mass Screening; Radionuclide Imaging; Succimer; Urinary Tract Infections; Urography; Vesico-Ureteral Reflux

We evaluated the predictors of renal scar in children with urinary tract infections (UTIs) having primary vesicoureteral reflux (VUR). Data of patients who were examined by dimercaptosuccinic acid (DMSA) scintigraphy between 1995 and 2005 were evaluated retrospectively. Gender, age, reflux grade, presence/development of scarring, breakthrough UTIs, and resolution of reflux, were recorded. The relation of gender, age and VUR grade to preformed scarring and the relation of gender, age, VUR grade, presence of preformed scarring, number of breakthrough UTIs and reflux resolution to new scarring were assessed. There were 138 patients [male/female (M/F) 53/85]. Multivariate analysis showed that male gender [odds ratio (OR) 2.5], age > or = 27 months in girls (OR 4.2) and grades IV-V reflux (OR 12.4) were independent indicators of renal scarring. On the other hand, only the presence of previous renal scarring was found to be an independent indicator for the development of new renal scar (OR 13.4). In conclusion, while the most predictive variables for the presence of renal scarring among children presenting with a UTI were male gender, age > or = 27 months in girls, and grades IV-V reflux, the best predictor of new scar formation was presence of previous renal scarring.

Topics: Age Factors; Child; Child, Preschool; Cicatrix; Cohort Studies; Female; Humans; Kidney; Male; Multivariate Analysis; Predictive Value of Tests; Radionuclide Imaging; Retrospective Studies; Risk Factors; Severity of Illness Index; Sex Factors; Succimer; Urinary Tract Infections; Vesico-Ureteral Reflux

The association of vesicoureteral reflux, urinary tract infection and renal scarring is well recognized. We evaluated the incidence of renal parenchymal scarring in a large series of infants with primary high grade vesicoureteral reflux.. The medical records of 549 consecutive infants with primary high grade vesicoureteral reflux between 1985 and 2006 were reviewed. A total of 473 infants (86.1%) presented with febrile urinary tract infections, 63 (11.5%) were screened for sibling vesicoureteral reflux and 13 (2.4%) were investigated because of prenatally diagnosed hydronephrosis. Age at diagnosis was defined as patient age at the first voiding cystourethrogram. Renal parenchymal scarring was evaluated by dimercapto-succinic acid scan and classified into 3 groups, including mild--focal defects with between 40% and 45% relative uptake of renal radionuclide, moderate--relative uptake between 20% and 40%, and severe--a shrunken kidney with relative uptake less than 20%.. Of the 549 infants 292 (53%) were boys and 257 (47%) were girls with a median age of 6 months (range 2 to 12). Reflux was unilateral in 160 and bilateral in 389 (938 ureters). Reflux grade was II to V in 19, 372, 458 and 89 ureters, respectively. All patients with grade II reflux had high grade reflux on the contralateral side. Renal parenchymal scarring was present in 122 of the 458 infants (27%) evaluated with dimercapto-succinic scan. The incidence of renal parenchymal scarring was only 9% in infants without a history of urinary tract infection and 29% in those who presented with a urinary tract infection (p <0.01). Moderate to severe renal parenchymal scarring was present in 55 infants, of whom 73% were male and 27% were female.. The data show that moderate to severe renal scarring is associated with grade IV and V reflux, and male sex. The incidence of renal scarring is significantly lower in infants in whom high grade vesicoureteral reflux is detected by screening before the development of urinary tract infection. Early detection may prevent urinary tract infection related renal parenchymal scarring.

Topics: Cicatrix; Female; Humans; Infant; Kidney; Male; Retrospective Studies; Succimer; Urinary Tract Infections; Vesico-Ureteral Reflux

Routine radiological evaluation in children with urinary tract infections includes ultrasound. Additional dimercapto-succinic acid scintigraphy in this setting is a common but not routine practice to determine whether there is parenchymal injury. Because dimercapto-succinic acid scintigraphy involves further time, expense and radiation, we determined whether ultrasound findings could substitute for dimercapto-succinic acid scintigraphy. Therefore, in children with urinary tract infections we researched the incidence of discordant findings between dimercapto-succinic acid scintigraphy and normal ultrasound.. A retrospective review of children with a history of urinary tract infections who had normal ultrasound and dimercapto-succinic acid scintigraphy within 6 weeks of each other was performed through a chart review. Children with pyelonephritis within 4 months of the radiological tests were excluded. Dimercapto-succinic acid scintigraphy was considered abnormal if there was less than 40% differential function, global atrophy or focal defects.. From January 2005 to December 2006, 100 children met inclusion criteria. Median patient age was 4.5 years (range 4 months to 19 years) and 84% were female. Of the 100 children 74 (74%) demonstrated vesicoureteral reflux and 18 (18%) showed abnormal dimercapto-succinic acid scintigraphy despite normal ultrasound. Children with vesicoureteral reflux showed an increased incidence of abnormal dimercapto-succinic acid scintigraphy compared to those without vesicoureteral reflux (20.3% vs 11.5%), although this did not attain statistical significance (p = 0.04).. Although dimercapto-succinic acid scintigraphy is not part of routine practice in all children with urinary tract infections and/or vesicoureteral reflux, it is frequently abnormal despite normal ultrasound. Therefore, dimercapto-succinic acid scintigraphy should be considered in these patients to evaluate cortical defects and possibly guide further management.

Topics: Adult; Child; Child, Preschool; Female; Humans; Infant; Kidney Diseases; Male; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Succimer; Ultrasonography; Urinary Tract Infections; Vesico-Ureteral Reflux

Topics: Cicatrix; Humans; Kidney Diseases; Pyelonephritis; Radionuclide Imaging; Succimer; Urinary Tract Infections; Vesico-Ureteral Reflux

Topics: Animals; Chelating Agents; Child; Child, Preschool; Cicatrix; Female; Guidelines as Topic; Humans; Infant; Kidney; Kidney Diseases; Male; Succimer; Sweden; Swine; United Kingdom; Urinary Tract Infections; Vesico-Ureteral Reflux

Topics: Anti-Bacterial Agents; Drug Administration Schedule; Early Diagnosis; Female; Humans; Infant; Kidney Diseases; Male; Prognosis; Radionuclide Imaging; Risk Assessment; Severity of Illness Index; Succimer; Treatment Outcome; Urinary Tract Infections

Assessment of first febrile urinary tract infection in young children has usually involved 2 imaging techniques: renal ultrasonogram and voiding cystourethrography. Currently, there is growing interest in using the dimercaptosuccinic acid (DMSA) scan labeled with technetium-99m as an alternative initial study, in the evaluation of UTI. DMSA renal scanning is the most sensitive radiologic study to detect acute pyelonephritis. Early DMSA renal scanning has been called the top-down approach, because the focus is the identification of kidney injury rather than reflux. Positive and negative aspects of DMSA renal scans are discussed by a pediatric urologist.

Topics: Female; Humans; Infant; Pyelonephritis; Radiography; Succimer; Technetium; Tomography, Emission-Computed; Urinary Tract Infections

To determine whether a normal technetium-99m-labeled dimercaptosuccinic acid (DMSA) renal scan obviates the need for voiding cystourethrography (VCUG) in evaluating young children after their first urinary tract infection (UTI).. This was a 10-year retrospective review of 142 children (age < or = 2 years, 77 boys and 65 girls) who had their first UTI and were admitted to a tertiary care general hospital. The association between DMSA renal scan results and VCUG results performed 48 hours and 1 month after diagnosis was evaluated.. DMSA renal scans and VCUG were performed in 142 patients. Of these, 99 patients (69.7%) had evidence of pyelonephritis, although only 2 (1.4%) had evidence of renal scarring; 42 (29.6%) had vesicoureteral reflux (VUR) on VCUG. The sensitivity, specificity, positive and negative predictive values, and likelihood ratio negative for abnormalities on DMSA renal scans for detecting the the presence of VUR on VCUG were 88% (95% confidence interval [CI] = 73% to 100%), 36% (95% CI = 26% to 46%), 37% (95% CI = 27% to 46%), 88 % (95% CI = 73% to 100%), and 0.33 (95% CI = 0 to 0.88), respectively.. Children with a negative DMSA renal scan during their first UTI episode rarely have VUR and may never have high-grade VUR. Avoiding VCUGs in children with negative DMSA renal scans could significantly reduce the use of this potentially traumatic test.

Topics: Child, Preschool; Female; Follow-Up Studies; Humans; Infant; Male; Predictive Value of Tests; Retrospective Studies; Severity of Illness Index; Succimer; Technetium; Urinary Tract Infections; Urography

There is an ongoing debate over the radiological investigations of children with urinary tract infections (UTIs) with some authorities suggesting that ultrasound scan (USS) alone is an accurate tool to diagnose renal parenchymal scarring post-pyelonephritis. All studies on this subject have been performed at paediatric teaching centres whereas most children with UTIs are managed by General Paediatricians in District General Hospitals (DGHs) in the United Kingdom. We wished to identify whether results of scans in DGHs differed from those in teaching centres.. We looked at all children with a clinical history of UTIs having a DMSA and USS over a one year period in two DGHs and one teaching centre. A total of 476 children's results were reviewed, 297 from the DGHs and 179 from the teaching centre.. The cohort had a total of 949 renal units. There were 79 scarred renal units (kidneys) on DMSA (8%) in 72 patients (15%). Just 18 renal units were detected as being scarred on USS (22.8%). Nine of 32 scarred renal units in the teaching centre were detected compared with nine of 47 in the DGHs (P = 0.40). Thirty-nine (49%) of the scarred renal units were in patients >5-years old. Of these 12 (30.7%) were detected on USS, nine of 17 within the teaching centre compared with just three of 22 at the DGHs (P = 0.01).. Overall only a small percentage of scars are detected on USS. In the over 5-year old group, where USS alone might be preferred, DGHs were significantly worse at detecting scarred kidneys. We conclude that if the detection of renal scars is a prime reason for imaging in children with UTIs, ultrasonography alone is inappropriate at any age and DMSA ought to be the primary investigation.

Topics: Chelating Agents; Child; Child, Preschool; Cicatrix; Cohort Studies; Female; Humans; Infant; Kidney; Kidney Diseases; Male; Reproducibility of Results; Retrospective Studies; Succimer; Ultrasonography; Urinary Tract Infections

Topics: Child; Humans; Practice Guidelines as Topic; Succimer; Ultrasonography; Urinary Tract Infections

To assess the utility of positional instillation of contrast (PIC) cystography in detecting vesicoureteral reflux (VUR) in patients with renal scarring from recurrent febrile urinary tract infections that standard voiding cystourethrography and nuclear cystogram imaging failed to reveal.. Between June 2004 and November 2004, a total of 5 pediatric patients with recurrent febrile urinary tract infections and radiologic evidence of upper tract involvement were examined with PIC cystography. All patients had at least one previous negative standard reflux study (voiding cystourethrography or nuclear cystography).. All 5 patients showed VUR on PIC cystography. Unilateral reflux was detected in 3 patients, and 2 patients had bilateral VUR.. The PIC cystogram should be integrated into the algorithm for diagnosing patients with recurrent febrile urinary tract infection, who do not exhibit VUR on standard imaging modalities. The morbidity associated with undiagnosed VUR, as demonstrated by this group of patients, suggests that permanent renal damage may be prevented by early diagnosis and treatment.

Topics: Absorbable Implants; Administration, Intravesical; Adolescent; Algorithms; Biocompatible Materials; Child; Child, Preschool; Contrast Media; Dextrans; Female; Humans; Hyaluronic Acid; Male; Posture; Pyelonephritis; Radionuclide Imaging; Radiopharmaceuticals; Recurrence; Succimer; Urinary Bladder; Urinary Tract Infections; Urography; Urologic Surgical Procedures; Vesico-Ureteral Reflux

In the absence of specific symptomatology in children, the early diagnosis of acute pyelonephritis is a challenge, particularly during infancy. In an attempt to differentiate acute pyelonephritis from lower urinary tract infection (UTI), we measured intrarenal resistive index (RI). We evaluated its ability to predict renal involvement as assessed by dimercaptosuccinic acid (DMSA) scintigraphy. In total 157 patients admitted to the pediatric department of the Sişli Etfal Hospital with clinical signs of febrile UTI were included in the study. The children were divided into groups according to their age at the time of ultrasonography (US). RI was measured from the renal arteries with Doppler US in the first 72 h in all 157 children. Renal involvement was assessed by (99m)Tc-DMSA scintigraphy in the first 7 days after admission. The examination was repeated at least 6 months later if the first result was abnormal. All available patients with an abnormal scintigraphy underwent voiding cystourethrography 4-6 weeks after the acute infection. All patients with vesicoureteral reflux and scarred kidneys were excluded from the study. DMSA scintigraphy demonstrated abnormal changes in 114 of 157 children and was normal in the remaining 43 children. Of these 114 children, 104 underwent repeat scintigraphy, of whom 77 showed partially or totally reversible lesion(s). Of these 77 children, 17 children (22%) with vesicoureteral reflux were excluded. Thus, we compared the 43 children with lower UTI with the 60 children with definite acute pyelonephritis at admission. Kidneys with changes of acute pyelonephritis had a mean RI of 0.744+/-0.06 in infants, 0.745+/-0.03 in preschool children, and 0.733+/-0.09 in patients of school age with upper UTI. However, the mean RI was 0.703+/-0.06 in infants, 0.696+/-0.1 in preschool children, and 0.671+/-0.09 in school-aged patients with lower UTI. The mean RI values were significantly higher in patients with upper UTI ( P<0.001). There was a highly significant correlation between RI values and the severity of the renal lesion as ranked by DMSA scintigraphy ( P<0.001). When the cut-off RI value was 0.715, there was an 80% sensitivity and a 89% specificity for diagnosing upper UTI. Refluxing kidneys and scarred kidneys also had higher RI values. In conclusion, RI values were increased significantly in children with febrile UTI when renal parenchymal involvement (assessed by DMSA scintigraphy) was present. Our results also support the vi

Topics: Child; Child, Preschool; Cicatrix; Escherichia coli Infections; Female; Fever; Humans; Infant; Male; Predictive Value of Tests; Prospective Studies; Radionuclide Imaging; Risk Assessment; Severity of Illness Index; Succimer; Ultrasonography, Doppler, Color; Urinary Tract Infections; Vesico-Ureteral Reflux

To investigate the incidence of acute pyelonephritis (APN) and renal scarring in children with febrile urinary tract infection (UTI), 191 of 216 (88%) children with their first episode of UTI received (99m)Tc-dimercaptosuccinic acid renal single-photon emission computed tomography. They were investigated within 7 days of admission and were followed for 6 months. One hundred and six patients (49.1%) underwent a voiding cystourethrogram. The incidence of vesicoureteric reflux (VUR) in group I (

Topics: Acute Disease; Adolescent; Anti-Bacterial Agents; Chelating Agents; Child; Child, Preschool; Cicatrix; Female; Follow-Up Studies; Humans; Infant; Kidney; Male; Pyelonephritis; Succimer; Tomography, Emission-Computed, Single-Photon; Urinary Tract Infections; Vesico-Ureteral Reflux

Urinary tract infection (UTI) is one of the most common causes of unexplained fever in neonates. The aim of this study was to determine the incidence of urinary tract anomalies and acute renal damage in neonates who presented with first urinary tract infection in the first 8 weeks of life. We reviewed the records of 95 infants, who were hospitalised with UTI during a 6-year period (1994-1999). Patients with antenatally diagnosed hydronephrosis and incomplete radiological investigations were excluded from the study. Of the remaining 57 patients, 42 were boys and 15 girls. The mean age at diagnosis was 32 days (range 5-60 days). All patients underwent renal ultrasonography (US), voiding cystourethrogram (VCUG) and (99m)Tc-dimercaptosuccinic acid (DMSA) scan. Urinary tract abnormalities were detected in 20 (35%) patients. Vesicoureteral reflux (VUR) was found in 19 (33%) neonates, 7 girls and 12 boys. Acute cortical defects on DMSA scan were present in 19 kidneys of patients with VUR and in 25 of those without reflux. Only one-third of neonates after first symptomatic UTI had VUR. We recommend that US, VCUG, and DMSA scan should be routinely performed after the first UTI in infants younger than 8 weeks.

Topics: Acute Disease; Chelating Agents; Female; Humans; Infant; Infant, Newborn; Kidney; Male; Radionuclide Imaging; Retrospective Studies; Succimer; Urinary Tract Infections; Vesico-Ureteral Reflux

The correlation between urinary tract infection (UTI), vesicoureteric reflux (VUR) and renal scarring was studied in 89 patients (177 renal units; 1 solitary kidney) during the period 1997-2000. There were 63 males and 26 females; ages ranged from neonates to 14 years. UTI was diagnosed on the basis of a positive urine culture, VUR was diagnosed and graded by micturating cystourethrogram (MCU), and renal scarring was assessed by technetium 99 m Tc-dimercaptosuccinic acid (DMSA) scan. Ultrasonography (US) was done to evaluate renal tract dilatation and other structural abnormalities. A follow up DMSA scan was performed approximately 6 months after the initial scan. VUR was present in 106 of the 171 renal units in which it was studied and absent in 65 units. The majority of the VUR was grade V. Renal scars were seen in 90 of 177 renal units at presentation and in 72 of the 163 renal units studied at follow-up. Some information was lacking in 31 patients; hence, the correlation between UTI, VUR, and renal scarring was done in 58 patients. The majority of the suspected scars at presentation were not seen at follow-up, but most of the established scars persisted. Only 2 renal units showed scars for the first time on follow-up. On US, approximately 50% of normal kidneys showed either suspicious or established scars on DMSA scan, and patients with bilateral abnormality on US showed renal scars. Renal scars were seen in 15 of 23 children without VUR, 17 of 18 with unilateral VUR, and 16 of 17 with bilateral VUR. Thus, there is a cause-and-effect relationship between UTI and renal scarring that is made worse by VUR. DMSA scans have been shown to be the most reliable method of assessing renal scarring, and an abnormal US scan showing upper-tract dilatation or a structural abnormality may have a predictive value in the detection of renal scarring.

Topics: Adolescent; Chelating Agents; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Kidney; Male; Radionuclide Imaging; Succimer; Ultrasonography; Urinary Tract Infections; Vesico-Ureteral Reflux

In the absence of specific symptomatology in children, the early diagnosis of acute pyelonephritis is a challenge, particularly during infancy. In an attempt to differentiate acute pyelonephritis from lower urinary tract infection (UTI), we measured serum procalcitonin (PCT) levels and compared these with other commonly used inflammatory markers. We evaluated the ability of serum PCT levels to predict renal involvement, as assessed by dimercaptosuccinic acid (DMSA) scintigraphy. Serum C-reactive protein (CRP), leukocyte counts, and PCT levels were measured in 64 children admitted for suspected UTI. Renal parenchymal involvement was assessed by (99m)Tc-DMSA scintigraphy in the first 7 days after admission. In acute pyelonephritis, the median PCT level was significantly higher than in the lower UTI group (3.41, range 0.36-12.4 microg/l vs. 0.13, range 0.02-2.15 microg/l, P<0.0001). In these two groups, respectively, median CRP levels were 120 (range 62-249 mg/l) and 74.5 (range 14.5-235 mg/l, P=0.012) and leukocyte counts were 15,910/mm(3) (range 10,200-26,900) and 14,600/mm(3) (range 8,190-26,470, P=0.34). For the prediction of acute pyelonephritis, the sensitivity and specificity of PCT were 94.1% and 89.7%, respectively; CRP had a sensitivity of 100%, but a specificity of 18.5%. We conclude that serum PCT may be an accurate marker for early diagnosis of acute pyelonephritis.

Topics: Acute Disease; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Child, Preschool; Diagnosis, Differential; Escherichia coli Infections; Female; Humans; Infant; Infant, Newborn; Kidney; Leukocyte Count; Male; Prognosis; Prospective Studies; Protein Precursors; Pyelonephritis; Radionuclide Imaging; Sensitivity and Specificity; Succimer; Urinary Tract Infections

Topics: Child; Child, Preschool; Cicatrix; Humans; Infant; Kidney; Patient Selection; Radionuclide Imaging; Succimer; Urinary Tract Infections

To assess the frequency of urinary tract anomalies in male neonates <8 weeks old who presented with urinary tract infection (UTI), and to evaluate a suitable imaging approach after the initial infection.. During a period of 4.5 years, from July 1994 through December 1998, 45 male neonates <8 weeks old (range: 5-56 days; mean: 23.77 days) with UTI were hospitalized. All patients had an ultrasound (US) and a voiding cystourethrogram (VCUG), except 1 neonate in whom VCUG was unsuccessful because of technical problems. A dimercaptosuccinic acid (DMSA) scan was recommended to all patients but was performed only in 30 of 45, most of them with an abnormal VCUG. The renal scan was performed at least 4 months after the UTI.. Urinary tract abnormalities were observed in 22 of 45 male neonates. Nineteen had vesicoureteral reflux (VUR), 1 had VUR and a double collecting system, 1 had VUR and a posterior urethral valve, and 1 had an ureteropelvic junction stricture. Renal atrophy or scars, as demonstrated by DMSA scan, were detected almost exclusively in neonates with VUR grade 3 and above. Only 1 neonate with VUR grade 1 had a pathologic DMSA, and the US of this male also demonstrated renal atrophy. Escherichia coli was the pathogen in 62% (28 of 45), and 9 boys had bacteremia.. We suggest that US and VCUG should be performed routinely after the initial UTI in male neonates. Renal scan should be reserved for those cases in which the US suggests renal parenchymal damage or when VCUG detects VUR grade 3 and above.

Topics: Chelating Agents; Humans; Infant; Infant, Newborn; Male; Radionuclide Imaging; Succimer; Ultrasonography; Urinary Tract Infections; Urogenital Abnormalities; Vesico-Ureteral Reflux

The objective of the present paper was to review the use of the dimercaptosuccinic acid (DMSA) scan in urinary tract infection at British Columbia's Children's Hospital to determine the frequency of cortical defects and the association between vesico-ureteric reflux and the presence of cortical defects in children with urinary tract infection. A total of 129 consecutive children with a urinary tract infection referred for a DMSA scan in a 2-year period (January 1992-January 1994) were retrospectively studied. The results were analysed in terms of kidneys, and the incidence of cortical defects was determined. Eighty-eight patients (68%) had a radiographic micturating cysto-urethrogram within 6 months of the DMSA scan, and in this group the relationship of defects with vesico-ureteric reflux was determined. Overall, 81/258 (31%) of kidneys had a cortical defect on a DMSA scan. Of those who had a micturating cysto-urethrogram, 53/176 (30%) kidneys had vesico-ureteric reflux, and of those that had reflux, 21/53 (40%) had a cortical defect on a DMSA scan. In the group of children without reflux, 38/123 (31%) had a cortical defect. Renal cortical scan defects are common findings in paediatric urinary infection, and frequently occur in the absence of vesico-ureteric reflux. These defects represent either established scars or acute pyelonephritis that can proceed to scarring. The micturating cysto-urethrogram alone is insufficient as a screening modality to identify those kidneys at risk of renal scarring.

Topics: Acute Disease; Adolescent; Chi-Square Distribution; Child; Child, Preschool; Cicatrix; Female; Humans; Infant; Kidney Cortex; Male; Organotechnetium Compounds; Pyelonephritis; Retrospective Studies; Succimer; Tomography, Emission-Computed, Single-Photon; Urinary Tract Infections; Vesico-Ureteral Reflux

Accurate diagnosis of pyelonephritis using clinical and laboratory parameters is often difficult, especially in children. The main aims of this prospective study were to compare the value of different imaging techniques [renal sonography, cortical scintigraphy with technetium-99m dimercaptosuccinic acid (99mTc DMSA) and computed tomography (CT)] in detecting renal involvement in acute urinary tract infections and to determine the sensitivity of DMSA scans for permanent renal scars 6 months later.. Between February 1992 and January 1993, 55 children admitted to our pediatric unit with febrile symptomatic urinary tract infections were eligible for analysis. Ultrasonography (US), DMSA scanning and micturating cystourethrography were performed in every case. Only 18 children underwent CT. A second DMSA scan was performed in 48 children a mean of 7.5 months after the first.. US abnormalities were found in 25 children (45 %). The first DMSA scan showed a parenchymal aspect suggestive of pyelonephritis in 51 patients (93 %). Among the 18 patients studied by CT, 14 had abnormalities. Normal US findings did not rule out renal parenchymal involvement. Scintigraphy appeared to be more sensitive than CT for renal involvement. The frequency and degree of initial renal parenchymal damage seemed to correlate with vesicoureteral reflux, but the most severe initial parenchymal defects were not associated with marked clinical or laboratory manifestations. Repeat DMSA scans, performed on 45 kidneys with abnormalities at the first examination, showed resolution in 19, improvement in 16, persistence in 8 and deterioration in 2. The prevalence of vesicoureteral reflux was not higher in patients with renal scarring on the second DMSA scan than in patients whose scans showed an improvement.. DMSA scans should be considered as a reference in the detection and follow-up of renal scarring associated with acute urinary tract infection as this technique is more sensitive than US and CT, the latter being unsuitable because it entails radiation exposure and sedation of patients.

Topics: Acute Disease; Adolescent; Child; Child, Preschool; Cicatrix; Diagnostic Imaging; Disease Progression; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Kidney; Kidney Diseases; Male; Organotechnetium Compounds; Prevalence; Prospective Studies; Pyelonephritis; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Tomography, X-Ray Computed; Ultrasonography; Urethra; Urinary Bladder; Urinary Tract Infections; Urination; Vesico-Ureteral Reflux

Topics: Age Factors; Body Temperature; C-Reactive Protein; Child; Child, Preschool; Female; Humans; Infant; Male; Organotechnetium Compounds; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections; Vesico-Ureteral Reflux

Established renal scarring represents areas of the kidney that imaging reveals to be damaged at presentation for medical management of urinary tract infection. New renal scarring represents new renal damage in parts of the kidney that imaging reveals to be normal at presentation. We attempted to characterize patients in whom new renal scars developed while they were under our care.. In 1988 a data base was started to identify patients with new renal scarring. All patients presenting with urinary tract infections were enrolled. Our data base has 250 possible fields per event with multiple events per patient. More than 2,100 patients have been enrolled to date. All patients with pyelonephritis, defined as a febrile urinary tract infection with flank pain and tenderness, and all with reflux underwent dimercapto-succinic acid (DMSA) scan at least 4 months after presenting with infection to assess established renal scars. New renal scars were identified when new renal defects were demonstrated on a second DMSA scan.. In our data base there are 1,426 patients with urinary tract infections, 685 (46%) with pyelonephritis and 1,062 (74.5%) with vesicoureteral reflux, including 558 found to have bilateral vesicoureteral reflux and 504 diagnosed with unilateral reflux. A history of daytime urinary incontinence was noted in 538 patients (37.7%), 192 (13.5%) had established scars at initial presentation and in 31 (2.1%) new renal scars developed while they were under our care, including 30 with established scars as well. Of the 25 patients in whom new renal scars developed while on medical therapy 11 underwent surgery. In 6 patients with dysfunctional voiding who were receiving medical treatment renal scars developed postoperatively. Surgery was performed in 17 of the 31 patients and 24 (77%) with new renal scars had a history of dysfunctional voiding.. Previous characterizations of patients with new renal scars have relied on excretory urography for assessing renal architecture and ignored voiding patterns of the children affected. Using the DMSA scan we identified 31 children with reflux, urinary tract infection and dysfunctional voiding in whom new renal scars developed while they were under our care.

Topics: Adolescent; Child; Child, Preschool; Cicatrix; Female; Humans; Infant; Kidney Diseases; Male; Prospective Studies; Pyelonephritis; Radiography; Succimer; Urinary Incontinence; Urinary Tract Infections; Vesico-Ureteral Reflux

Congenital maldevelopment is sometimes found in small kidneys with ureteral reflux. However, the incidence of congenitally small kidneys and the frequency of its association with ureteral reflux remains unknown. Ultrasound scanning, performed in 4,000 apparently healthy neonates or young infants (males 2,129, females 1,871), detected 51 children suspected of having small kidneys. A careful ultrasound re-examination performed one month later in 45 of the 51 children confirmed small kidneys in eight children, one bilateral and seven unilateral. Dimercaptosuccinate (DMSA) renoscintigraphy revealed small kidneys with generally diminished uptake in six infants and no uptake unilaterally in the other two infants. One of the 12 children, who had normal findings on the initial scanning and subsequently developed urinary infection, was later diagnosed having unilateral small kidney with generally reduced DMSA uptake. All seven infants having small kidneys with reduced tracer uptake were male (incidence, 1:300 boys). All eight small kidneys in the seven boys and four of the six contralateral non-small kidneys were associated with ureteral reflux, while neither of the two infants with a non-functioning kidney had ureteral reflux. Serial ultrasounds documented the poor growth of all small kidneys. Thus, congenitally small kidneys with generally diminished DMSA uptake were highly associated with ureteral reflux and especially observed in boys.

Topics: Female; Follow-Up Studies; Humans; Incidence; Infant; Infant, Newborn; Kidney; Kidney Diseases; Male; Radiography; Radionuclide Imaging; Succimer; Ultrasonography; Urinary Tract Infections; Vesico-Ureteral Reflux

A prospective study was performed on 185 children with symptomatic urinary tract infection (UTI), 130F and 55M, having a median age of 0.9 y (range 0.1-9.8) at the time of UTI. The aim of the study was to find out how the 99mTechnetium-dimercaptosuccinic acid (DMSA) scan should be used to investigate UTI, and to follow the development of renal changes during pyelonephritis into subsequent permanent renal damage. All children were investigated with a DMSA scan within 5 days after admission and after 3.9-53.3 (median 9.2) weeks, and 159 were studied again after approximately 2 y (range 1.5-3.9 y). They all underwent micturition cystourethrography at the time of the second study. At the time of infection, the DMSA scan was abnormal in 85% of the children, in 58% at the first follow-up and in 36% at the second follow-up. An abnormal DMSA scan performed within 20 weeks from infection became normal in 38% of cases on the third study, while only 1/10 abnormal DMSA scans performed more than 20 weeks after infection became normal after 1.5-3.9 y. Persistent renal changes were more common in children > 4 y of age than in children < or = 1 y of age. Two months after the presenting infection, it was unusual to see a normal DMSA scan in a child with a VUR gr. > or = 3. The study suggests that DMSA changes after an index UTI may be transient for a longer period of time than has been previously considered. Therefore, in order to detect persistent changes, a DMSA scan should be performed more than 5 months after UTI.

Topics: Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Kidney; Male; Organotechnetium Compounds; Prospective Studies; Pyelonephritis; Radionuclide Imaging; Recurrence; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Time Factors; Urinary Tract Infections; Urography

To determine up to what age children remain at risk of developing a new renal scar from a urinary tract infection.. Follow up study. Families of children who had normal ultrasound scans and scanning with dimercaptosuccinic acid (DMSA) after referral with a urinary tract infection when aged 3 (209) or 4 (220) were invited to bring the children for repeat scans 2-11 years later. A history of infections since the original scan was obtained for children not having a repeat scan.. Teaching hospital.. Children from three health districts in whom a normal scan had been obtained at age 3-4 years in 1985-1992 because of a urinary tract infection.. Frequency of new renal scars in each age group.. In each group, about 97% of children either had repeat scanning (over 80%) or were confidently believed by their general practitioner or parent not to have had another urinary infection. The rate of further infections since the original scan was similar in the 3 and 4 year old groups (48/176 (27%)) and 55/179 (31%)). Few children in either group known to have had further urinary infections did not have repeat scanning (3/209 (1.4%) and 4/220 (1.8%)). In the 3 year old group, 2.4% (5/209) had one or more new kidney scars at repeat scanning (one sided 95% confidence interval up to 5.0%), whereas none of the 4 year olds did (one sided 95% confidence interval up to 1.4%). The children who developed scars were all aged under 3.4 years when scanned originally.. Children with a urinary tract infection but unscarred kidneys after the third birthday have about a 1 in 40 risk of developing a scar subsequently, but after the fourth birthday the risk is either very low or zero. Thus the need for urinary surveillance is much reduced in a large number of children.

Topics: Adolescent; Child; Child, Preschool; Cicatrix; Follow-Up Studies; Humans; Kidney Diseases; Radionuclide Imaging; Risk Factors; Succimer; Urinary Tract Infections

Topics: Adolescent; Child; Child, Preschool; Cicatrix; Female; Humans; Infant; Kidney Diseases; Male; Radionuclide Imaging; Referral and Consultation; Succimer; Urinary Tract Infections

Ninety children referred to hospital with urinary tract infections (UTI) were investigated by intravenous urography (IVU), ultrasonography (US) and 99m-Tc dimercaptosuccinic acid scan (DMSA). Fifty-eight children also had a micturition cystourethrography performed. In 36 (40%) of the children at least one result was abnormal. In 29 children IVU was abnormal, 10 had abnormal US and 16 had abnormal DMSA. Six of the 58 children had vesicoureteric reflux in eight kidneys. In 16 children IVU was the only examination with an abnormal result, and in ten of these the findings were considered important for treatment or prognosis. In conclusion, IVU is an important supplement to US and DMSA in investigation programs for children with UTI. IVU should be performed in cases of renal scarring or dilatation and in children with recurrent infections.

Topics: Chelating Agents; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Male; Prognosis; Radionuclide Imaging; Retrospective Studies; Succimer; Ultrasonography; Urinary Tract Infections; Urography

We compared the prognostic stratification of primary vesicoureteral reflux by performing staging voiding cystourethrography in all children with a urinary tract infection or only in those with renal scarring on 99mtechnetium-dimercapto-succinic acid (DMSA) scintigraphy.. Staging voiding cystourethrography and DMSA scintigraphy were performed in 105 children with a urinary tract infection and reflux persistence was assessed by radionuclide cystography after a 2-year followup.. Staging voiding cystourethrography revealed no reflux in 51 children (DMSA positive in 3), grades I to II reflux in 21 (DMSA positive in 6) and grade III reflux in 33 (DMSA positive in 19). On followup radionuclide cystography no new reflux was detected, and it was no longer demonstrated in 23 children (8 with grade III and 15 with grades I to II reflux). The finding of grade III reflux on staging voiding cystourethrography had a 76% positive and a 92% negative value for predicting persistent reflux with an 87% predictive accuracy. Limiting the evaluation of voiding cystourethrography data to the 28 children with a positive DMSA scan the combination of renal scarring and grade III reflux had an 84% positive and an 83% negative predictive value with 83% accuracy. This approach would have prevented 77 children from having to undergo voiding cystourethrography.. Performance of staging voiding cystourethrography exclusively in children with renal scarring on a DMSA scan resulted in predictive accuracy that was close to what was achieved by performing voiding cystourethrography in all children with a urinary tract infection. To be able to limit cystourethrography to a select population could prove to be cost-effective.

Topics: Case-Control Studies; Child, Preschool; Female; Follow-Up Studies; Humans; Male; Organotechnetium Compounds; Predictive Value of Tests; Prognosis; Radiography; Radioisotope Renography; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Time Factors; Urethra; Urinary Bladder; Urinary Tract Infections; Urination; Vesico-Ureteral Reflux

During a 2 year period, 175 children below 6 years of age (median 0.4 year) with non-obstructive symptomatic urinary tract infection were studied by 99mTc dimercaptosuccinic acid (DMSA) scintigraphy. DMSA scintigraphy was performed at a median of 10 days after the start of treatment and was abnormal in 73 children (42%), equivocal in 29 (16%) and normal in 73 (42%). Reflux was seen in 27% of all children and in 38% of the renal units that were abnormal at DMSA scintigraphy. A decreasing frequency of abnormalities at DMSA scintigraphy was seen within the first 14 days after the start of treatment. C-reactive protein and grade of reflux correlated significantly with abnormal DMSA studies. To demonstrate renal involvement in acute urinary tract infection, DMSA scintigraphy should be performed within days after the start of treatment. It is noteworthy that reflux was seen in less than half of renal units with abnormal DMSA scintigraphy.

Topics: Acute Disease; Age Factors; Anti-Bacterial Agents; Body Temperature; C-Reactive Protein; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Male; Organotechnetium Compounds; Radionuclide Imaging; Reproducibility of Results; Risk Factors; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections; Urography; Vesico-Ureteral Reflux

Urinary tract infection (UTI) is a common condition in children and may lead to renal scarring with a risk of later hypertension and renal insufficiency. We made a cross-sectional study of the 99mTc-DMSA findings in 496 children referred for following symptomatic UTI to a Department of Nuclear Medicine and we categorized the results, to provide a framework for further study.. A standard 99mTc-DMSA protocol was used to study 496 children (157 males, 339 females) aged from birth to 14 yr. Findings were classified according to the image appearance and relative function of each kidney. These were related to age, sex, history and timing of UTI and the results on micturating cysto-urethrography (MCU).. Images were normal, with function within limits (45%-50% in one kidney), in approximately half the boys and girls studied. The other images were classified as equivocal in 68 children, abnormal unilaterally in 105 and bilaterally in 76, and they were subdivided according to the image appearance. No image changes could be identified that were specifically associated with acute UTI. Diffuse change alone was uncommon. A high proportion of abnormal images was found in infant boys, older girls with recurrent UTI and those children with vesico-ureteric reflux (VUR). Of the bilateral abnormal images, 98% were seen in children with VUR.. Our findings suggest that infective renal change may be superimposed on underlying congenital lesions (perhaps detectable antenatally) or may be acquired following UTI in the presence of reflux and are thus potentially preventable. This study also suggests that VUR is almost certain to have occurred in a child who has bilateral abnormal 99mTc-DMSA images following UTI and is also commonly present in those with definite unilateral defects.

Topics: Adolescent; Age Factors; Child; Child, Preschool; Cross-Sectional Studies; Female; Humans; Infant; Infant, Newborn; Kidney; Male; Organotechnetium Compounds; Radionuclide Imaging; Recurrence; Sex Factors; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Time Factors; Urinary Tract Infections; Vesico-Ureteral Reflux

The aim of this study was to determine whether age, C-reactive protein (CRP), body temperature, or results of voiding cystourethrography at diagnosis of first-time symptomatic urinary tract infection could predict the risk of renal damage as evaluated by dimercaptosuccinic acid (DMSA) scintigraphy performed 1 year after the infection.. The study included 157 children (median age, 0.4 year, range, 5 days to 5.8 years) with first-time symptomatic urinary tract infection. In children 1 year of age or older, a body temperature of 38.5 degrees C or higher was necessary for inclusion. CRP and body temperature were measured at the time of infection, and voiding cystourethrography was performed shortly thereafter. DMSA scintigraphy was performed 1 year later in all children.. After 1 year, 59 (38%) of the 157 children had renal damage as evaluated by DMSA scintigraphy, and of these, 28 (47%) had reflux. There was a positive correlation between renal damage and CRP, body temperature, and reflux. Children with high levels of CRP, high fever, and dilating reflux had a risk of renal damage up to 10 times higher than children with normal or slightly elevated CRP levels, no or mild fever, and no reflux.. CRP concentration and body temperature at the index infection, in combination with the results of voiding cystourethrography, are useful in classifying children at high and low risk of scintigraphic renal damage 1 year after urinary tract infection.

Topics: Age Factors; Body Temperature; C-Reactive Protein; Child; Child, Preschool; Follow-Up Studies; Humans; Infant; Infant, Newborn; Kidney; Kidney Diseases; Logistic Models; Organotechnetium Compounds; Prospective Studies; Radiography; Radionuclide Imaging; Risk Factors; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Time Factors; Urinary Bladder; Urinary Tract Infections

To estimate the prevalence of vesicoureteral reflux (VUR) and renal scarring in children presenting with culture proven urinary tract infections (UTI).. Descriptive study.. Tertiary care hospital-based study.. Thirty-two children with proven UTI were evaluated by means of an abdominal ultrasonogram (USG), Technetium-99m Dimercapto Succinic Acid (DMSA) scan and Direct Radionuclide Cystography (DRCG). A micturating cystourethrogram (MCU) was performed to rule out any structural abnormality and to grade VUR.. A total of 64 renal units in 32 children were evaluated. DMSA scan showed scarring in 27 renal units (42.2%) in 16 patients. Bilateral renal scarring was more common in older (> 2 yr) children as compared to younger ones (89% Vs 43%; p < 0.05). USG detected abnormalities in 13 renal units (20.3%) in 7 cases. VUR was detected in 37.5% of children of all age group by DRCG. In contrast, MCU showed evidence of VUR in only 13/20 renal units with a sensitivity of 65% as compared to DRCG and did not pick up any additional VUR that could have been missed on the DRCG. Only 3/9 in < 2 yr, in contrast to 10/11 in > 2 yr were positive for VUR on MCU (p < 0.05). However, MCU detected evidence of cystitis in 3 children and a bladder diverticulum in one patient.. Wherever available, DMSA scan should be considered as a part of the first line investigations in any patient presenting with UTI. DRCG can also be performed in the same sitting to screen for the presence of reflux particularly for girls.

Topics: Child; Child, Preschool; Female; Humans; Infant; Male; Organotechnetium Compounds; Radionuclide Imaging; Sensitivity and Specificity; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections; Urodynamics; Vesico-Ureteral Reflux

This prospective study was designed to investigate the most relevant radiological approach for the evaluation of urinary tract infections (UTI) in childhood. In the first 48 hours following the diagnosis of UTI, all patients underwent 99mTc dimercaptosuccinic acid (DMSA) scanning, ultrasonography (US) and intravenous urography (IVU). For the imaging of renal parenchymal infection the sensitivity of IVU and US as compared to DMSA scanning were found to be 9.09% and 25%, respectively. It was concluded that 99mTc DMSA, where available, should be the first step for the accurate diagnosis and follow-up of patients with UTI.

Topics: Algorithms; Child, Preschool; Diagnostic Imaging; Female; Humans; Male; Organotechnetium Compounds; Prospective Studies; Sensitivity and Specificity; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections

Although planar cortical scintigraphy has been demonstrated to be a sensitive test for the detection of renal infection and scarring, one criticism has been radiation dose to the renal cortex. Recent studies of cortical SPECT suggest a sensitivity for detection of lesions equal to, or greater than, that of planar scans. The authors prospectively performed SPECT scans on 36 patients referred for recurrent urinary tract infection (UTI) (11 of 36), or recent onset of symptoms of UTI (25/36) after 30-40% of the standard 130 MBq (3.5 mCi) adult dose of Tc-99m DMSA was administered. Comparison was made with ultrasonography (US) performed at, or near, the same time. Of 67 kidneys evaluated, 34 (51%) demonstrated focal cortical loss on Tc-99m DMSA scintigraphy, 1 kidney was small in size, and 32 kidneys were normal. Abnormalities were noticed in only 13 (19%) of kidneys on US. Previously, US has been the primary imaging modality in the evaluation of the young patient with UTI. Triple-headed Tc-99m DMSA SPECT scintigraphy is a more sensitive, low-dose (12 mGy, 1.2 r) method of detecting renal cortical abnormalities. As such, it is a more appropriate test for identifying sites of cortical infection and scarring and for following patients on prophylactic therapy for evidence of asymptomatic break-through infections.

Topics: Acute Disease; Child; Female; Humans; Kidney Cortex; Male; Organotechnetium Compounds; Prospective Studies; Pyelonephritis; Radiation Dosage; Sensitivity and Specificity; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Tomography, Emission-Computed, Single-Photon; Ultrasonography; Urinary Tract Infections

Ninety children referred to hospital with urinary tract infection (UTI) were investigated by iv urography (IVU), ultrasonography (US) and 99mTc dimercaptosuccinic acid scan (DMSA). Fifty-eight children also underwent micturating cystourethrography (MCUG). In 36 (40%) of the children, at least one result was abnormal. Abnormal findings were found in 29 children with IVU, in 10 with US and in 16 with DMSA. Six of the 58 children had vesicoureteric reflux (VUR) in 8 kidneys. In 16 children, IVU was the only examination with an abnormal result, and in 10 of these the findings were considered important for treatment or prognosis. IVU is an important supplement to US and DMSA in investigation programs for children with UTI. IVU should be performed in cases of renal scars, dilatations or in children with recurrent infections.

Topics: Adolescent; Chi-Square Distribution; Child; Child, Preschool; Contrast Media; Female; Humans; Infant; Injections, Intravenous; Iohexol; Male; Organotechnetium Compounds; Predictive Value of Tests; Radionuclide Imaging; Retrospective Studies; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Ultrasonography; Urethra; Urinary Bladder; Urinary Tract Infections; Urography

The optimal regimen for investigating children with urinary tract infection (UTI) remains uncertain. Ultrasonography, contrast micturating cystourethrography (MCU), intravenous urography (IVU), and technetium-99m dimercaptosuccinic acid (DMSA) studies were performed in 58 children with UTI under 14 years of age attending two teaching hospitals and the results compared. All four investigations were normal in 12 children. In 36 with vesicoureteric reflux (VUR) on MCU, dilatation was reported on ultrasonography in eight children. Radiological renal scarring was seen in 20 children; it was suspected on ultrasonography in nine, with dilatation alone in four, and a normal report in seven. Duplex kidneys identified on IVU were unrecognised on ultrasonography or DMSA studies; ultrasonography showed no change corresponding to presumed acute defects on DMSA studies that later resolved. Disparities were observed at all ages. This study suggests that ultrasonography is unreliable in detecting VUR, renal scarring, or inflammatory change and, alone, is inadequate for investigating UTI in children.

Topics: Child; Child, Preschool; Female; Humans; Kidney; Male; Organotechnetium Compounds; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Ultrasonography; Urinary Tract Infections; Urography; Vesico-Ureteral Reflux

The histories and imaging results are presented in 10 children in whom errors had been made in the interpretation of early investigations. Ultrasonography may not detect either vesicoureteric reflux (VUR) or renal scars or inflammation. The reduced nephrogram or renal swelling following a first attack of acute pyelonephritis may not be recognised without renal measurement on an intravenous urogram. Renal scarring may be diagnosed incorrectly on the basis of functional defects of isotope uptake on a technetium 99m-dimercaptosuccinic acid study. In the absence of VUR, the micturating cystogram will not visualise the kidneys.

Topics: Child; Child, Preschool; Diagnostic Errors; Female; Humans; Infant; Male; Organotechnetium Compounds; Radiography; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Ultrasonography; Urinary Tract Infections; Vesico-Ureteral Reflux

The initial 99mTc-DMSA studies carried out over a four year period in 229 patients with various heterogenic causes of lower urinary tract abnormalities were reviewed. Anatomical damage to the renal parenchyma was graded by means of planar and SPECT studies into a six group classification proposed by Monsour et al.: grade 0 (normal), I (equivocal), II (single defect), III (more than 2 defects), IV (contracted or small) and V (no visualization). Parenchymal uptake of 99mTc-DMSA was quantitated from planar images at 2 hours postinjection by a computer assisted gamma camera method. SPECT studies could enhance the pick-up rate for parenchymal uptake defects by a factor of 1.5 in comparison with planar imaging. The incidence of anatomical damage to the renal parenchyma increased with a high radiological grade for VUR, and renal uptake per injection dose of 99mTc-DMSA by the individual kidney significantly decreased in grades III and IV of the anatomical classification. These data revealed that 99mTc-DMSA planar is still useful for evaluating gross structural damage and for quantitative evaluation of the kidney with computer assistance. SPECT scintigraphy is more effective in disclosing anatomical damage to the renal parenchyma than planar, although it needs further discussion as to whether SPECT may increase sensitivity with minimal or no adverse affect on specificity.

Topics: Adult; Child; Gamma Cameras; Humans; Kidney; Organotechnetium Compounds; Retrospective Studies; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Tomography, Emission-Computed; Tomography, Emission-Computed, Single-Photon; Urinary Tract Infections; Vesico-Ureteral Reflux

Planar renal scintigraphy with Tc-99m DMSA has become established as a standard diagnostic test to determine if a kidney has been scarred by infection. It has been suggested that high resolution SPECT may improve the sensitivity of detection of renal scars. To determine if it is possible to produce good quality renal SPECT with a short acquisition time, 10 adults were examined with a new multi-detector gamma camera using 8 minute, 16 minute, and 32 minute acquisitions. The number of defects seen (N = 16) with an 8 minute acquisition was not significantly different from the defects (N = 15) seen using a 16 minute and a 32 minute acquisition. In adults when imaging with a multi-detector gamma camera there was no clinical advantage in using an acquisition of longer than 8 minutes.

Topics: Adolescent; Adult; Female; Gamma Cameras; Humans; Kidney; Kidney Diseases; Male; Middle Aged; Organotechnetium Compounds; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Tomography, Emission-Computed, Single-Photon; Urinary Tract Infections

Topics: Child; Child, Preschool; Diagnostic Imaging; Humans; Infant; Kidney; Organotechnetium Compounds; Pyelonephritis; Radioisotope Renography; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Tomography, Emission-Computed, Single-Photon; Urinary Tract Infections; Vesico-Ureteral Reflux

Topics: Child; Child, Preschool; Diagnostic Imaging; Female; Humans; Kidney; Male; Organotechnetium Compounds; Pyelonephritis; Radioisotope Renography; Sensitivity and Specificity; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections; Vesico-Ureteral Reflux

Topics: Child; Child, Preschool; Diagnostic Imaging; Female; Humans; Infant; Male; Organotechnetium Compounds; Pyelonephritis; Radioisotope Renography; Succimer; Sugar Acids; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections; Vesico-Ureteral Reflux

Sixty-eight patients (135 kidneys) with varied renal pathology were evaluated with 99Tcm-dimercaptosuccinic acid (DMSA) single photon emission tomography (SPET) to determine whether it is possible to detect more renal abnormalities and to reduce the number of false-positives due to anatomical variants when compared with planar imaging. The patients ranged in age from 1 to 78 years and their pathologies included urinary tract infection (n = 50), space occupying lesions (n = 5), calculi (n = 4), hypertension (n = 4) and others (n = 5). Planar scans were performed 3 h after the injection of 80 MBq of 99Tcm-DMSA and a 64 x 20 s acquisition over 360 degrees was used for SPET. High-resolution collimation was used for both. Slices were displayed as transaxial, coronal and sagittal and/or oblique sagittal in the plane of the kidney. Three-dimensional (3D) images were formed by volume rendering. Each kidney was divided into three regions and each region scored separately for the presence of an abnormality. Planar scans were reviewed alone and then in conjunction with SPET and 3D images. Planar imaging detected 95 abnormal regions compared with 103 using SPET. SPET reduced the number of equivocal regions in 8 (12%) patients. The diagnosis was altered by SPET in 17 (4%) regions in 14 (21%) patients. SPET and 3D 99Tcm-DMSA allow more abnormalities to be detected but also allow more specific definition of apparent abnormalities on planar imaging.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Female; Humans; Image Processing, Computer-Assisted; Infant; Kidney; Kidney Diseases; Male; Middle Aged; Organotechnetium Compounds; Radioisotope Renography; Sensitivity and Specificity; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Tomography, Emission-Computed, Single-Photon; Urinary Tract Infections

When studying a child with urinary tract infection it is important to detect and localize any renal (scar) or urologic anomaly. Here we study the information obtained using: renal and vesical ultrasound (US), DMSA scan and radiologic or isotopic cystogram.. We studied 148 children with more than one urinary infection and/or pyelonephritis; their mean age was 35.9 months (1-148 months); 55% were girls. The three diagnostic examinations--US, DMSA scan and cystogram were made in this order; the DMSA scan or cystogram was never made sooner than one month after the UTI.. In 42% of the children the three exams were normal; 4 of these children had another UTI and the urodynamic study revealed vesical disfunction. 11% had renal scars (DMSA scan) with normal US and cystogram; 30% had VUR, 50% of which had an altered US and 57% had renal scars on the DMSA scan. 12% of the children had an altered US with a cystogram showing no VUR; 66% of these had renal scars. 4% had vesical anomalies in the US and cystogram.. The three exams chosen were able to direct the diagnostic approach of UTI, being sufficient in most of the cases. We would like to emphasize the importance of the DMSA scan in diagnosing unsuspected renal scars.

Topics: Acute Disease; Child; Child, Preschool; Evaluation Studies as Topic; Female; Humans; Infant; Kidney; Male; Organotechnetium Compounds; Pyelonephritis; Radionuclide Imaging; Recurrence; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Ultrasonography; Urinary Bladder; Urinary Tract Infections

This study examined whether renal parenchymal imaging using 99mTc DMSA scintigraphy with tomography is a sensitive measure of renal scarring in renal transplant recipients with an abnormal lower urinary tract and whether such scars correlate with impairment of renal function. Three groups of patients were compared: group 1, patients with an abnormal lower urinary tract and deteriorating renal function (n = 9); group 2, abnormal lower urinary tract and stable renal function (n = 5); and group 3, normal lower urinary tract and deteriorating renal function (n = 8). Eight of the nine patients in group 1 had multiple scars visible on 99mTc DMSA scans and this correlated with histology when a renal biopsy was performed; the only patient without scars had a transplant glomerulopathy. The presence of scars was associated with either raised intravesical pressures or recurrent urinary tract infections (UTIs). Only one patient in each of groups 2 and 3 had visible scars and both these patients had a history of recurrent UTIs. Patients in group 3 with deteriorating renal function due to chronic rejection documented by biopsy did not have cortical scars visible with 99mTc DMSA tomography. 99mTc DMSA scanning with tomography is a useful investigation in the management of renal transplant patients with declining renal function; multiple scars may indicate abnormal lower urinary tract function and are not seen in chronic rejection.

Topics: Cicatrix; Humans; Kidney; Kidney Failure, Chronic; Kidney Transplantation; Organotechnetium Compounds; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Tomography, Emission-Computed, Single-Photon; Urinary Tract; Urinary Tract Infections; Urodynamics

There is an ongoing debate on the best way to screen febrile infants for urinary tract infection. We examined the urinanalysis (UA) findings on admission among infants less than 16 weeks old, with and without acute pyelonephritis (APN), as defined by the dimercaptosuccinic acid (DMSA) renal scan findings, performed during a 57-month period. Forty-nine cases with a positive DMSA scan were compared with 79 negative study cases. A negative UA for leukocytes (< 5 white blood cells/high power field) was found in 4 of 49 (8.1%) cases with APN by DMSA, and in 34 of 79 (43%) cases with a negative DMSA (odds ratio 10.88 (95% confidence interval, 2.31 to 70.3; P < 0.001)). Three of the 4 infants not suspected to have APN by their UA findings would have been admitted for a full sepsis workup based on their clinical presentation and/or their laboratory findings on admission. We conclude that a fresh UA may be a sufficient screening method for the exclusion of APN in infants assessed for fever of no obvious origin.

Topics: Acute Disease; Bacterial Infections; Diagnosis, Differential; Female; Fever of Unknown Origin; Humans; Infant; Infant, Newborn; Leukocyte Count; Male; Pyelonephritis; Radionuclide Imaging; Retrospective Studies; Succimer; Urinalysis; Urinary Tract Infections

To assess the value of an ultrasound examination in children with a proven urinary tract infection.. The results of renal ultrasound and 99mTc-dimercapto-succinic acid (DMSA) studies were compared in 112 children with a first documented symptomatic Escherichia coli urinary tract infection.. Ultrasound was particularly effective in detecting the presence of obstruction, renal swelling and parenchymal change consistent with acute pyelonephritis. However, ultrasound failed to detect half of the kidneys with photon deficient areas on 99mTc DMSA scan and was unreliable in detecting the presence of scarring.. An ultrasound examination alone should not be relied on in the child with an acute urinary tract infection.

Topics: Adolescent; Child; Child, Preschool; Escherichia coli Infections; Female; Humans; Infant; Kidney Diseases; Male; Organotechnetium Compounds; Prospective Studies; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Ultrasonography; Ureteral Obstruction; Urinary Tract Infections

Routine DMSA scintigraphy, ultrasound (US) of the kidney, intravenous pyelography (IVP) and voiding cystoureterography (VCU) were performed in 27 consecutive adult women with recurrent acute pyelonephritis (APN) during a 12-month follow-up. Both planar and single photon emission computed tomography (SPECT) images were obtained for DMSA scan. DMSA scans were repeated in those patients with abnormal initial scan. DMSA-SPECT showed normal findings in 2, single renal cortical detect (RCD) in 9 and multiple RCD in 16 (including nonvisualization in 2). Of the 11 kidneys with normal findings or single RCD on DMSA-SPECT, only 1 (9%) showed vesicoureteral reflux (VUR) on VCU (grade I). A large proportion of those with multiple RCDs showed abnormal findings on IVP (44%, 7/16), US (38%, 6/16) or VCU (31%, 5/16); 63% in any of these three studies. 5 of 6 patients with VUR had multiple RCDs on DMSA-SPECT, and 3 of these 5 showed no abnormality on IVP or US. 7 patients who needed other managements besides initial standard antibiotic treatment had multiple RCDs on DMSA-SPECT. 15 normal women were also studied and showed normal DMSA-SPECT, US and IVP, in all cases. Follow-up DMSA-SPECT was done in 16 patients (7 with single RCD, 9 with multiple RCD). All 7 patients with single RCD showed improvement, in those with multiple RCDs improvement was observed in 2, no change in 7 on follow-up studies. We conclude: (1) DMSA-SPECT is a useful initial diagnostic tool in adult women with recurrent APN to identify patients who need more extensive radiological studies.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Female; Humans; Kidney; Middle Aged; Organotechnetium Compounds; Pyelonephritis; Radiography; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Tomography, Emission-Computed; Tomography, Emission-Computed, Single-Photon; Ultrasonography; Urinary Tract Infections

A retrospective review was performed of 100 enuretic children who underwent isotope renography during the period 1981-1989. Studies performed were Tc99mDMSA studies for renal size and to detect renal scarring and renography using Tc99mDTPA or MAG3 to evaluate excretion and detect vesicoureteric reflux. Fifty-five children had microbiological evidence of urinary tract infection (UTI), and 16 (29%) of these had abnormalities on their isotope studies. Forty-five had sterile urine and all had normal isotope studies. Thus despite recent reports of urodynamic abnormalities and increased incidence of reflux in patients with enuresis, our findings indicate that standard nuclear medicine renal studies show few abnormalities in patients with monosymptomatic enuresis. The 29% incidence of abnormal studies in patients with enuresis and UTIs suggests that the presence of infection should be an indication for further investigation in this subgroup of enuretic children.

Topics: Adolescent; Child; Child, Preschool; Enuresis; Female; Humans; Kidney; Male; Organotechnetium Compounds; Radioisotope Renography; Retrospective Studies; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Mertiatide; Technetium Tc 99m Pentetate; Urinary Tract Infections; Vesico-Ureteral Reflux

The results of investigations in children with urinary tract infection (UTI) were studied in a district general hospital in order to assess the relative value of the two most widely used screening tests, namely ultrasound (US) and 99mTc dimercaptosuccinic acid (DMSA) scintigraphy. A total of 193 children had undergone both US and DMSA scintigraphy as part of an investigation of proven single or multiple urinary tract infections over a 27 month period. DMSA scintigraphy revealed abnormalities in 22 of the children (11%). The abnormalities ranged from cortical defects to congenital anatomical abnormalities. US revealed abnormalities in six children (3%) but did not contribute any additional information in any. In our institution, the DMSA scintigram alone would have been an adequate screening test for children with UTI. Hydronephrosis is a common abnormality detected by US. Although none were seen in the study group, several children were examined during the study period with dilated collecting systems detected at ante-natal US. No cases of hydronephrosis presented as UTI. We question whether the use of routine US is justifiable in the investigation of children with UTI, and discuss whether a more selective investigation protocol should be adopted.

Topics: Adolescent; Child; Child, Preschool; Diagnostic Tests, Routine; Female; Humans; Infant; Male; Organotechnetium Compounds; Radionuclide Imaging; Recurrence; Retrospective Studies; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Ultrasonography; Urinary Tract; Urinary Tract Infections

Dimercaptosuccinic acid (DMSA) renal scans were performed on 75 children (115 refluxing renal units) to determine the efficacy of routine scanning in patients with various grades of vesicoureteral reflux. Cystourethrography demonstrated grades I and II reflux in 75 renal units and grades III to V in 40. Of the patients 51 presented with febrile urinary tract infection and 24 were asymptomatic (patients presenting with nonfebrile urinary tract infections or those undergoing sibling screening). Renal ultrasounds were performed in 60 patients. All patients were initially managed with medical therapy and 19 (25%) ultimately underwent antireflux surgery. DMSA scans demonstrated scarring in 17 of 40 renal units (43%) of patients with high grade vesicoureteral reflux and 6 of 75 renal units (8%) of those with low grade reflux. Renal ultrasounds that were interpreted as normal always correlated to a normal DMSA scan in asymptomatic patients. In patients presenting with febrile urinary tract infections the correlation between ultrasound and DMSA scan was inconsistent. We advocate a tailored approach in the evaluation of patients with vesicoureteral reflux. Renal sonography may be sufficient in the assessment of renal scarring in asymptomatic patients with reflux and those with low grade reflux. Conversely, in patients with high grade vesicoureteral reflux, a history of febrile urinary tract infections and abnormal renal ultrasound DMSA renal scans appear to be most useful.

Topics: Child; Child, Preschool; Cicatrix; Female; Fever; Humans; Infant; Infant, Newborn; Kidney; Kidney Diseases; Male; Organotechnetium Compounds; Predictive Value of Tests; Radioisotope Renography; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Ultrasonography; Urinary Tract Infections; Vesico-Ureteral Reflux

Urinary N-acetyl-beta-glucosaminidase (NAG) and beta-2-microglobulin (B2M) concentrations were measured in 24 pediatric patients with febrile urinary tract infection (UTI) and compared with the technetium-99m-labeled dimercaptosuccinic acid (DMSA) renal scan results, in order to evaluate a noninvasive means to localize the site of UTI. Increased urinary B2M and NAG were not associated with renal inflammation (pyelonephritis), as defined by positive dimercaptosuccinic acid scan. Median NAG concentrations were 114.2 mumol/hour/mg creatinine (CR) (range, 5.7 to 305.4) in 17 febrile UTI patients vs. 13.8 (range, 3.4 to 104.3) in 17 age and sex-matched febrile controls with negative urine cultures, P = 0.0001. The sensitivity and specificity of NAG > or = 40 mumol/hour/mg of CR in predicting UTI in febrile patients, regardless of the site of infection, were 88 and 88%, respectively. Increased urinary NAG is associated with UTI in febrile patients regardless of the level of infection (scan status), and may be an informative indicator of UTI.

Topics: Acetylglucosaminidase; beta 2-Microglobulin; Biomarkers; Child; Child, Preschool; Clinical Enzyme Tests; Fever; Humans; Infant; Infant, Newborn; Organotechnetium Compounds; Sensitivity and Specificity; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections

The purpose of this prospective study is to compare 3 types of 99mTc-DMSA renal scan [(a) planar, (b) x-ray type film static SPECT presentation (SPECT-1) and (c) dynamic three-view display of SPECT slices (SPECT-2)], intravenous urography, and ultrasonography in the diagnosis of renal scars. All these studies were performed in 130 pediatric patients, with urinary tract infection (42 patients), vesicoureteral reflux (37), and unilateral or bilateral small kidney(s) (51). The number of renal scars detected was highest with the 99mTc-DMSA renal SPECT-1 scan and next came the 99mTc-DMSA renal SPECT-2 studies. There is a significant difference (p < 0.05) between the ability of planar and SPECT-1 to recognize renal defects. However, SPECT-2 may provide the best stereotactic localization and image quality of all the methods.

Topics: Child, Preschool; Diagnostic Imaging; Female; Humans; Kidney; Male; Organotechnetium Compounds; Prospective Studies; Sensitivity and Specificity; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Tomography, Emission-Computed, Single-Photon; Urinary Tract Infections; Vesico-Ureteral Reflux

In order to estimate the normal range of chromium-51 ethylene diamine tetra-acetic acid (EDTA) clearance in children, we selected a series of 256 patients with past or present urinary tract infection who showed, at the time of the clearance determination, normal technetium-99m dimercaptosuccinic acid (DMSA) scintigraphy and normal left to right DMSA relative uptake. The clearance was calculated by means of either the simplified second exponential method or the 120-min single blood sample; Chantler's correction was used in order to correct for having neglected the first exponential. There was a progressive increase in clearance from the first weeks of life (mean value around 1 month: 55 ml/min/1.73 m2), with a plateau at around 18 months. Between 2 and 17 years of age, the clearance values remained constant, with a mean value of 114 ml/min/1.73 m2 (SD: 24 ml/min); this is similar to the level described for inulin clearance. No significant differences were observed between boys and girls, or between clearance values calculated with one or with two blood samples. Taking into account the hour of intravenous injection of the tracer, we did not observe any influence of the lunchtime meal on the distribution of the 51Cr-EDTA clearance values.

Topics: Adolescent; Child; Child, Preschool; Chromium Radioisotopes; Edetic Acid; Female; Glomerular Filtration Rate; Humans; Infant; Kidney; Male; Organotechnetium Compounds; Radioisotope Renography; Reference Values; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections

We designed a prospective study to evaluate the ability of dimercaptosuccinic acid cortical scintigraphy and ultrasonography to detect renal parenchymal lesions in children with pyelonephritis. One hundred eleven patients 1 week to 16 years of age (median 5.5 months) with a urine culture positive for pathogens were included in the study; cortical scintigraphy and ultrasonography were repeated in 25 children after a mean follow-up of 10.5 months. Cortical scintigraphy showed renal changes in 74 children (67%), and ultrasonography showed renal changes in 39 (35%) (p < 0.001); results of the two examinations were discordant in 49 patients (kappa = 0.19). Children more than 1 year of age had a higher incidence of renal lesions than did younger children (85% vs 66%; p = 0.04). The presence of inflammatory signs (erythrocyte sedimentation rate or C-reactive protein) had an 89% sensitivity and a 25% specificity in identifying renal lesions. Among children with renal changes, vesicoureteric reflux was present in 39%. At follow-up examination, 16 children (64%) had scars. Thus we found a high incidence of renal involvement in children with pyelonephritis. We found that cortical scintigraphy is more sensitive than ultrasonography in detecting renal changes, and we believe that it should be added to the initial examination of children with suspected pyelonephritis.

Topics: Adolescent; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Kidney Cortex; Male; Organotechnetium Compounds; Prospective Studies; Pyelonephritis; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Ultrasonography; Urinary Tract Infections

This study describes the pathologic changes underlying the appearances of the 99mTc-DMSA renal image during acute pyelonephritis induced in piglets by a combination of vesicoureteral reflux (VUR) and urinary infection. In a total of 42 animals examined, pathologic lesions were identified in 36 of the 46 kidneys subjected to VUR and urinary infection, but no lesions developed in the remaining 10 refluxing kidneys. While scintigraphic defects were invariably associated with pyelonephritic lesions (specificity 100%), some small lesions were not identified (sensitivity 80%). There was a significant association (p = < 0.001) between the degree of photon deficiency seen scintigraphically and the histologic changes (early and late lesions). However, the scintigraphic appearance of individual lesions was also influenced by factors such as their extent and density, so that consideration of the macroscopic characteristics was also important for precise correlation.

Topics: Acute Disease; Animals; Cicatrix; Female; Organotechnetium Compounds; Pyelonephritis; Radionuclide Imaging; Sensitivity and Specificity; Succimer; Swine; Technetium Tc 99m Dimercaptosuccinic Acid; Time Factors; Urinary Tract Infections; Vesico-Ureteral Reflux

The site of a urinary tract infection (UTI) is located by clinical findings plus imaging techniques. Renal imaging with technetium 99mTc-dimercaptosuccinic acid (99mTc-DMSA) has shown promise but its efficacy for detecting acute pyelonephritis is still debated as is its ability to differentiate between acute, potentially curable disease and scarring, definitive changes.. The files of all the 166 patients that underwent one or two (32 patients) 99mTc-DMSA imaging sessions for UTI in 1989 and 1990 in our department were analysed. The results of this technique were compared with the clinical and laboratory data and with those of other imaging techniques (ultrasonography and retrograde voiding cystourethrogram). The patients (92 girls and 74 boys, mean age: 5 years, range 15 days-17 years) were assigned to one of 3 categories: 1) acute pyelonephritis (27 patients), 2) low UTI (60 patients) and 3) uncertain UTI (79 patients), on the basis of the clinical and laboratory data.. The first 99mTc-DMSA imaging was normal in 110 children; changes were unilateral in 45 and bilateral in 11 children. Images suggesting either acute or chronic changes were observed respectively in 19 and 48 children. 4 of the 7 acute changes were normalized on the second radioisotope scanning while 2 became worse; 19 of the 23 chronic changes were unchanged at the second scanning. Radioisotope scanning changes were seen in 81% of the patients classified as acute pyelonephritis and in only 27% of those with lower UTI. Reflux was detected in 56% of abnormal kidneys and in 36% of normal kidneys. The results of radioisotope scanning and ultrasound scan findings were not correlated in 24 patients (19 only abnormal radioisotope imaging, 5 only abnormal ultrasound scan).. DMSA scans are useful for investigating and following UTI. They help to distinguish acute pyelonephritis and lower UTI. It is a reliable method of detecting structural abnormalities and identifying children at risk of progressive renal damage.

Topics: Adolescent; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Male; Organotechnetium Compounds; Pregnancy; Pyelonephritis; Radiography; Radionuclide Imaging; Succimer; Ultrasonography; Urinary Bladder; Urinary Tract Infections

Topics: Acute Disease; Child, Preschool; Female; Humans; Male; Organotechnetium Compounds; Prospective Studies; Pyelonephritis; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Ultrasonography; Urinary Tract Infections

Renal cortical scintigraphy with 99Tcm-dimercaptosuccinic acid is an excellent imaging modality for the detection of renal cortical defects in children presenting with vesicoureteric reflux and urinary tract infections. Single photon emission computed tomography (SPECT) has proven increased sensitivity over planar scintigraphy for lesion detection in the heart, liver and brain. However, its role in the evaluation of renal cortical defects compared to planar scintigraphy has not been fully assessed. We wished to determine whether SPECT increases the sensitivity for detecting renal cortical defects in children compared to high-resolution planar scintigraphy. Forty-one children (90 renal units) with underlying vesicoureteric reflux and/or recently treated urinary tract infection (UTI) were evaluated. There was no statistically significant difference in the number of defects detected between a single-head SPECT system and high-resolution planar scintigraphy, 24 and 20, respectively (P = 0.54). There were four defects detected by SPECT not reported by planar scintigraphy; two of these were only seen retrospectively on planar scintigraphy. There were two children with renal cortical defects detected by SPECT and not by planar scintigraphy. All defects defected by planar scintigraphy were detected by SPECT. It is concluded that although the risk of missing renal cortical defects is low when using high-resolution, three-view planar scintigraphy, SPECT should be employed whenever feasible. Single photon emission computed tomography detected renal cortical defects in children not diagnosed by planar scintigraphy and hence patient management may be altered.

Topics: Child; Child, Preschool; Female; Humans; Infant; Kidney Cortex; Male; Middle Aged; Observer Variation; Ontario; Organotechnetium Compounds; Prospective Studies; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Tomography, Emission-Computed, Single-Photon; Urinary Tract Infections; Vesico-Ureteral Reflux

One hundred children with a proven urinary tract infection were studied prospectively using both ultrasound (US) and 99mTc dimercaptosuccinic acid (DMSA) scintigraphy to assess the efficacy of US in the detection of renal scarring. Sixty-nine girls and 31 boys with an age range of 0.5-11.8 years were studied. DMSA scintigraphy detected 19 scarred kidneys in 17 children. Scarring was classified as mild, moderate or gross. US detected a total of seven of the scarred kidneys (sensitivity 37%). US detected 0/6 kidneys with mild scarring, 1/7 kidneys with moderate scarring and 6/6 kidneys with gross scarring. Four kidneys with scarring on DMSA showed abnormalities other than scarring on US. 8/19 scarred kidneys were thought to be normal on US. It is important to detect renal scarring in young children and US cannot be relied upon for this purpose. It should therefore be supplemented with DMSA scintigraphy.

Topics: Child; Child, Preschool; Female; Humans; Infant; Kidney; Male; Organotechnetium Compounds; Prospective Studies; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Ultrasonography; Urinary Tract Infections

The use of 99mTechnetium dimercaptosuccinic acid (99mTc DMSA) scanning for the early diagnosis of upper urinary tract infections has been preferred for a few years. In this research we investigated the use of 99mTc DMSA scanning in the localization of renal parenchymal involvement in urinary tract infection. Twenty-four children presenting with first acute urinary tract infection were studied. Investigations included physical examination, white blood cell count (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), antibody-coated bacteria (ACB) and early 99mTc DMSA scanning. 99mTc DMSA scanning was taken as the gold standard method in determining renal parenchymal inflammation. According to the 99mTc DMSA scanning the sensitivity of clinical findings was 57.14%, WBC 23.80%, ESR 33.33%, CRP 14.28% and ACB 71.42% in the localization of urinary tract infection. We propose early 99mTc DMSA scanning performed around the time of infection as a good technique for localization of the level of infection in the urinary tract.

Topics: Bacterial Infections; Child; Female; Humans; Kidney; Kidney Diseases; Male; Organotechnetium Compounds; Physical Examination; Predictive Value of Tests; Sensitivity and Specificity; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Tomography, Emission-Computed, Single-Photon; Urinary Tract Infections

Observer error in the sonographic estimation of renal volume in children has not been reported. Knowledge of the possible magnitude of error is important in assessing abnormalities of renal growth. This study was undertaken to determine the error of sonographic measurements of relative renal volume by comparing them with measurements of relative renal function from 99mTc-dimercaptosuccinic acid (DMSA) scintigraphy.. The study included 52 children, 2 months to 16 years old, who had DMSA scintigraphy and renal sonography on the same day. The sonographic and scintigraphic studies were interpreted independently. Relative function of the right kidney as shown by DMSA scintigrams in the direct posterior view was compared with relative volume as determined with sonography. Renal volumes were calculated by using the formula for a prolate ellipsoid. The standard deviation of the differences (SDD) between relative renal function and relative renal volume was calculated, and the limits of agreement were derived.. Thirty-three children had normal renal morphology on both studies. Twenty-five kidneys in 19 children were abnormal on one or both studies, including 14 definitely scarred kidneys in 12 children. Relative function of the right kidney in patients with normal kidneys was 50.1 +/- 2.5%, including one possible outlying value. Normal relative volume of the right kidney was 49.1 +/- 3.1%. In patients with normal kidneys, the difference between relative function and relative volume of the right kidney was 1.0 +/- 2.8% with 95% limits of agreement of 6.7% and -4.7%. Agreement between relative function and relative volume was worse for children with abnormal kidneys; the mean difference was 2.0%, and the largest observed difference was 10.9%. Correlation between relative renal volume and relative renal function for all patients was high (r = .94), with 95% limits of agreement of 8.6% and -5.8%.. The agreement between relative renal function and relative renal volume was good. In children with normal kidneys, estimated relative renal volume derived from sonography can be expected to lie within 6.7% of the relative renal function determined scintigraphically.

Topics: Adolescent; Child; Child, Preschool; Humans; Infant; Kidney; Organotechnetium Compounds; Radioisotope Renography; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Ultrasonography; Urinary Tract Infections

In clinical practice, determining which patients with urinary tract infection have upper urinary tract involvement is difficult yet important for proper management. This report indicates that the 99mtechnetium dimercaptosuccinic acid (DMSA) scan is a useful test in making this determination.

Topics: Adolescent; Bacterial Infections; Child; Child, Preschool; Female; Humans; Infant; Kidney; Kidney Diseases; Male; Organotechnetium Compounds; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections

We performed 99mTc 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 99mTc DMSA, as compared to 23% with abnormal findings on US. Vesico-ureteral reflux was present in 38% of the kidneys with parenchymal involvement on 99mTc DMSA scan. Although fever, leucocytosis and elevated CRP and ESR were significantly correlated with abnormal 99mTc DMSA scan, they were also observed in children without renal parenchymal involvement. Our results suggest that 99mTc 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.

Topics: Acute Disease; Adolescent; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Kidney; Male; Organotechnetium Compounds; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Ultrasonography; Urinary Tract Infections; Urography

Static isotope imaging with 99mtechnetium-dimercaptosuccinic acid was performed at a mean age of 34 days in 32 children (50 kidneys) whose vesicoureteral reflux had been identified as a result of prenatal ultrasound scanning. Three patterns of isotope uptake were observed: 1) noninfected primary vesicoureteral reflux (15 children, 24 kidneys), 2) noninfected secondary (obstructed) vesicoureteral reflux (9 patients, 11 kidneys) and 3) infected primary reflux (8 infants, 15 kidneys). In 20 pattern 1 kidneys (83%) renal morphology and differential isotope were normal. In the 4 kidneys (17%) that showed evidence of impaired function this took the form of global parenchymal loss, that is small kidneys rather than focal scarring. In pattern 2 the combination of fetal vesicoureteral reflux and obstruction was a potent cause of renal damage with total or near total loss of function in 7 of 9 refluxing units associated with posterior urethral valves and in 2 kidneys with secondary ureteropelvic junction obstruction. Appearances of focal scarring were confined in pattern 3 and were found in 4 kidneys (27%). This overall incidence of detectable renal damage was lower than expected. Even when infection occurs, prenatal diagnosis may lessen the risk of scarring by enabling treatment to be instituted promptly. The findings suggest that uncomplicated primary vesicoureteral reflux is a relatively benign insult to the fetal kidney and that reflux nephropathy found in children presenting clinically is the result of infected vesicoureteral reflux in postnatal life. Any comparison of published studies will prove difficult until there is a more standardized approach to imaging technique and patient selection.

Topics: Female; Humans; Infant; Kidney Diseases; Male; Organotechnetium Compounds; Pregnancy; Radioisotope Renography; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Ultrasonography, Prenatal; Urinary Tract Infections; Vesico-Ureteral Reflux

A prospective study examining the incidence of dimercaptosuccinic acid (DMSA) abnormalities in children at the time of acute urinary tract infection, the progression of these abnormalities following treatment and their correlation with the presence of vesicoureteral reflux is reported. DMSA scans performed within 72 hours of presentation in 65 previously healthy children with acute urinary tract infection were abnormal in 34 (52%). The scan appearances of 30 of 36 (83%) initially abnormal kidneys improved or became normal on the repeat DMSA study performed at 3 to 6 months after the acute urinary tract infection. A cystogram demonstrated significant vesicoureteral reflux in 11 of 45 cases (24%). Of these 11 cases 10 had abnormal DMSA studies and 1 had dilated upper tracts on ultrasound. Several conclusions may be drawn from our study. The incidence of DMSA abnormalities at the time of acute urinary tract infection is high but these abnormalities tend to resolve with time. An abnormal DMSA study at the time of urinary tract infection identifies most children with significant vesicoureteral reflux, and in our series a combination of ultrasound and DMSA identified all cases. This study may have major implications for the clinical investigation of children with urinary tract infection.

Topics: Acute Disease; Child, Preschool; Female; Follow-Up Studies; Humans; Infant; Kidney Diseases; Male; Prospective Studies; Radiography; Radionuclide Imaging; Succimer; Urinary Tract Infections; Vesico-Ureteral Reflux

Topics: Child; Child, Preschool; Female; Humans; Infant; Male; Organotechnetium Compounds; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Ultrasonography; Urinary Tract Infections; Urography

A total of 106 children with symptomatic urinary tract infection (73 girls and 33 boys, 0-15.9 years of age) were studied by means of a dimercaptosuccinic acid (DMSA) scan, renal ultrasound, and a desmopressin test during infection and at follow up approximately two months later. At follow up they were also investigated by means of intravenous urography (IVU) and micturition cystourethrography (MCU). During infection 23 children had a normal DMSA scan while 83 children had an abnormal one. The median C reactive protein and SD score for renal concentration capacity in the former group were 15 (range < 10-178) mg/l and -1.0 SD score (range -2.4 to 1.8), respectively, and in the latter group 98 (range < 10-320) mg/l and -3.1 SD score (range -5.7 to 1.1), respectively. In the former group there was no significant finding in any child on ultrasound or IVU and only one had significant vesicoureteric reflux (VUR) (grade 3). At follow up 51 children had a normal DMSA scan while 55 children showed persistent changes. The median SD score for renal concentration capacity in the former group was -0.9 SD score (range -3.2 to 1.4) and in the latter group -1.6 SD score (range -4.6 to 2.5). No significant changes were found in the former group on ultrasound or IVU and only two children had significant VUR (grade 3). In the latter group 20 children showed changes on ultrasound, 15 showed changes on IVU, and 23 had VUR. These results suggest that a normal DMSA scan during or approximately two months after urinary tract infection in children indicates a low risk of finding significant pathology of the urinary tract.

Topics: Adolescent; Child; Child, Preschool; Deamino Arginine Vasopressin; Female; Follow-Up Studies; Humans; Infant; Male; Organotechnetium Compounds; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Ultrasonography; Urinary Tract; Urinary Tract Infections; Urography

Correlation of virulence factors of Escherichia coli with renal inflammation documented by 99mTc-dimercaptosuccinic acid renal scan was undertaken in 59 children with febrile urinary tract infections to identify more accurately the role of bacterial virulence factors in the development of pyelonephritis. P fimbriae were present in 63% of isolates from the positive scan group and 83% of those from the negative scan group (P = 0.126). Multivariate regression analysis showed no significant role for established E. coli virulence factors in the development of pyelonephritis. The pap genome was independently associated with negative scan (P less than 0.007) and with the absence of reflux (P = 0.031). E. coli pyelonephritogenic clone O16:K1:H6 was isolated from negative scan patients and did not produce hemolysin. We conclude that P fimbriae are important in the development of febrile urinary tract infection regardless of the level of infection. Virulent E. coli clones described in prior Scandinavian urinary tract infection studies were not common causes of pyelonephritis in our patient population.

Topics: Adolescent; Child; Child, Preschool; Escherichia coli; Escherichia coli Infections; Female; Fever; Fimbriae, Bacterial; Humans; Infant; Infant, Newborn; Male; Organotechnetium Compounds; Pyelonephritis; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections; Virulence

By means of Tc-99m dimercaptosuccinic acid (DMSA) scintigraphy, an established method for assessing renal cortical damage, we evaluated the pick-up rate for renal defects (scars) by single photon computed tomography (SPECT) and planar images of 10 normal volunteers, and 58 patients (70 scintigrams) with upper urinary tract infections, most of whom had a history of vesicoureteral reflux (VUR). The positive study rate for renal defects depended on the severity of VUR. The overall positive rates for renal cortical defects obtained by DMSA SPECT imaging and DMSA planar imaging were 60% and 43%, respectively, and the difference between these was significant (p less than 0.005). The mean absolute individual renal uptake (/injected dose) at 2 hours post-injection was decreased in kidneys with defects detected by SPECT alone. The positive study rate for intravenous urography (IVU) depended on the grade of VUR and was 15% overall. DMSA SPECT imaging detects renal cortical defects at greater frequency than previously achieved.

Topics: Adolescent; Adult; Child; Child, Preschool; Female; Humans; Infant; Kidney Cortex; Male; Middle Aged; Organotechnetium Compounds; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Tomography, Emission-Computed, Single-Photon; Urinary Tract Infections; Vesico-Ureteral Reflux

Voiding cystourethrography (VCU) of 407 children with vesicoureteral reflux (VUR) at our hospital during 1969-1990 was reviewed and 7 cases (8 ureters) of intrarenal reflux (IRR) were found. All the children were male and had had an episode of febrile urinary infection under one year of age. One child had a left flank mass, which was later proven a urinoma. VUR was moderate (grade III) in 3 and massive (grade IV and V) in 5. VUR was estimated as primary in one child and as secondary in 6 (anterior urethral ring 2, posterior urethral valve 2, neurogenic bladder 2). IRR was localized to the upper area in 3, to the lower area in 2, and to the whole kidney in 3. Sixty percent of those with IRR in the polar areas was associated with moderate VUR, whereas all of those in the whole kidney was with massive one. Renal scarring was assessed by excretory urography (IVP) and/or 99mTc-DMSA renoscintigraphy. Seven kidneys were evaluable; polar scars in 5, dwarf with polar scar in 1 and dwarf with poor function (suspected hypodysplasia) in 1. In 4 kidneys new scar formation was observed. It was noted, however, that IRR did not necessarily accompany renal scars of the corresponding areas and IRR to the whole kidney did not always lead to multiple scars in the whole kidney. The nature and problems of IRR, renal scars and 99mTc-DMSA renoscintigraphy were discussed. It was suggested that urinary infection played a greater part in renal scar formation.

Topics: Cicatrix; Humans; Infant; Infant, Newborn; Kidney; Kidney Diseases; Male; Organotechnetium Compounds; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections; Vesico-Ureteral Reflux

The relationship of vesicoureteric reflex (VUR) and renal scarring was studied in 94 children (188 kidneys) with proved urinary tract infection in a district general hospital. There were 61 girls and 33 boys, with nine girls and 17 boys aged less than 1 year, 31 girls and nine boys aged between 1 and 5 years, the remaining 28 children were over 5 years of age. All children had a micturating cystourethrogram and a 99mTc (technetium) dimercaptosuccinic acid (DMSA) scan. Forty two of the 188 kidneys were scarred and 70 of the kidneys had VUR. Only 37.1% of the kidneys with reflux were scarred but 61.9% of the scarred kidneys had VUR. In children of less than 1 year, 48% of kidneys with VUR were scarred whereas 70.6% of scarred kidneys had reflux. In children between 1 and 5 years of age only 36.4% of kidneys with VUR were scarred but 63.2% of scarred kidneys had VUR. There is good correlation between the detection of a scarred kidney on DMSA and the presence of vesicoureteric reflux. However the detection of reflux particularly in children over 1 year of age shows poor correlation with renal scarring. This suggests that the primary imaging in children over 1 year of age presenting with a urinary tract infection should be of the kidney: a cystogram should be performed only if the DMSA scan is abnormal.

Topics: Age Factors; Child; Child, Preschool; Cicatrix; Female; Humans; Infant; Infant, Newborn; Kidney; Kidney Diseases; Male; Radionuclide Imaging; Succimer; Urinary Tract Infections; Vesico-Ureteral Reflux

Dimercaptosuccinic acid (DMSA) studies were performed in 113 infants less than 1 year old at risk of renal scarring. Of these patients 86 presented with urinary tract infection and 27 were asymptomatic. A voiding cystourethrogram was performed in all cases and excretory urography (IVP) was done in 99. More abnormalities were detected by DMSA study when compared to scars on IVP. When both studies were abnormal there was an excellent correlation on a site by site basis. Fever or systemic disorder was not a reliable sign to determine whether there was upper tract involvement with infection. The incidence of DMSA abnormalities in infants increased with high grade vesicoureteral reflux and decreased with low grade reflux. There was no significant difference in the incidence of abnormal kidneys between the infected and noninfected groups, suggesting that renal scarring may occur with sterile reflux.

Topics: Female; Humans; Infant; Male; Organotechnetium Compounds; Prospective Studies; Pyelonephritis; Radioisotope Renography; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections; Urography; Vesico-Ureteral Reflux

Using the established piglet model, renal scars were produced by a combination of vesicoureteric reflux and urinary infection. The presence and extent of scarring, as determined by postmortem examination, was compared with that detected by technetium 99m dimercaptosuccinic acid (DMSA) scans performed before sacrifice. Sixty female piglets (62 refluxing units) were studied. Overall the sensitivity (true-positive/(true-positive + false-negative)) of DMSA scanning in detecting macroscopic scarring was 85% and the specificity (true-negative/(true-negative + false-positive)) was 97%. There were five false-negatives, four of which were in kidneys with minor scarring and one in which there was major scarring. There were three false-positives. We conclude that DMSA scanning has a high specificity and sensitivity in detecting renal scars in female piglets, and suggest it is the preferred method for detecting renal scars in clinical practice.

Topics: Animals; Escherichia coli Infections; False Negative Reactions; False Positive Reactions; Female; Kidney Diseases; Organotechnetium Compounds; Predictive Value of Tests; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Swine; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections; Vesico-Ureteral Reflux

24 children with symptomatic urinary tract infection (UTI) underwent systematically ultrasound studies (US) and 99mTc-DMSA renal scans. Among the 15 patients considered as acute pyelonephritis (APN) on clinical grounds, the scan was abnormal in 12 cases, in contrast with only 1 abnormal scan in the clinical subgroup of the lower UTI. Among the 10 abnormal scans that were repeated later on, 6 did completely normalize. US showed only once a parenchymal appearance suggestive for APN. Our findings suggest that the DMSA scan has to be considered at present as the most sensitive imaging technique for the detection of APN.

Topics: Acute Disease; Child, Preschool; Female; Humans; Kidney; Male; Organotechnetium Compounds; Pyelonephritis; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Tomography, Emission-Computed, Single-Photon; Ultrasonography; Urinary Tract Infections

Topics: Acute Disease; Child, Preschool; Cicatrix; Humans; Infant; Infant, Newborn; Kidney Diseases; Organotechnetium Compounds; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections

Topics: Age Factors; Cicatrix; Humans; Infant; Infant, Newborn; Kidney Diseases; Organotechnetium Compounds; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections

Topics: Child; Child, Preschool; Cicatrix; Female; Humans; Kidney Diseases; Organotechnetium Compounds; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections

Topics: Humans; Organometallic Compounds; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract; Urinary Tract Infections

Between 1985 and 1987 102 children, age 0-14 years, presented with a first acute symptomatic E. coli urinary tract infection. Investigations included early 99mtechnetium dimercaptosuccinic acid (DMSA) scan (which was performed at a median of 27 days), ultrasonography, micturating cysto-urethrography and indirect voiding radionuclide cystography using 99mTc DTPA. Follow-up DMSA scan was carried out after 6 months. Twenty-one of 102 of initial DMSA studies showed diminished uptake of radionuclide and 12 showed cortical scarring. Twenty-nine patients had significant vesicoureteral reflux (VUR). The finding of diminished uptake on the initial scan was significantly associated with fever, systemic upset, length of symptoms and a peripheral blood leucocytosis, (p less than 0.05). In addition the finding was associated with fever and loin pain in the older child. Both diminished uptake and scarring were more common in refluxing kidney units. We propose that, in children with UTI, diminished uptake on early DMSA scan localises infection in the renal parenchyma.

Topics: Acute Disease; Adolescent; Child; Child, Preschool; Escherichia coli Infections; Female; Humans; Infant; Kidney; Male; Nephritis; Organotechnetium Compounds; Prospective Studies; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections; Vesico-Ureteral Reflux

Forty five children presenting with a first proven urinary tract infection under the age of 5 years were studied by sequential 99mTc dimercaptosuccinic acid (DMSA) scans. Forty nine kidneys in 40 children had definite defects at presentation, and 39 (80%) of these defects were still present when the DMSA scan was repeated. Changes in the appearance of defects were independent of the presence or degree of reflux at presentation and of symptomatic recurrence of infection, though the combination of new infection and grade 3 reflux (reflux reaching the renal calices with distension) was associated with deterioration. No kidney with a relative DMSA uptake of less than 35% showed any improvement in its cortical defects. Only two kidneys that were initially without defects, in a single patient who had bilateral grade 3 reflux and breakthrough infections, developed defects on subsequent scans. The outcome after urinary tract infection is dependent on the effect of the first infection on the kidney. Occasionally children with grade 3 reflux develop damage during subsequent infections. More widespread use of DMSA scans should improve our understanding of the factors that determine the development of renal damage.

Topics: Child, Preschool; Follow-Up Studies; Humans; Infant; Infant, Newborn; Kidney; Kidney Cortex; Organotechnetium Compounds; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections; Vesico-Ureteral Reflux

A total of 115 children under 5 years who presented with a first symptomatic urinary tract infection and who had a 99mTc dimercaptosuccinic acid (DMSA) scan were studied to assess its value and compare the findings with those of other imaging techniques. Renal cortical defects were detected in 65 kidneys by DMSA scan, intravenous urogram, and ultrasound scan combined; 62 (95%) being seen on DMSA scan. The finding of reflux on micturating cystourethrography showed a highly significant correlation with renal defects seen on DMSA scanning, a less close but still significant correlation with abnormalities on intravenous urography, but none with ultrasound scan findings. The sensitivity of the DMSA scan in screening for all grades of reflux is estimated as 0.66, which is higher than that previously reported for the intravenous urogram or ultrasound scan. DMSA scans were less likely to miss grade 3 reflux than the other two methods. DMSA scans are more useful than other upper renal tract imaging techniques in detecting renal defects. Consideration should be given to their use as a first investigation in place of routine intravenous urograms. Ultrasound scans alone will overlook potentially serious urinary tract abnormalities.

Topics: Child, Preschool; Cicatrix; Female; Humans; Infant; Infant, Newborn; Kidney; Kidney Diseases; Male; Organometallic Compounds; Radiography; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Ultrasonography; Urinary Tract Infections; Vesico-Ureteral Reflux

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Kidney; Lithotripsy; Male; Middle Aged; Organometallic Compounds; Radioisotope Renography; Succimer; Sulfhydryl Compounds; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Calculi; Urinary Tract Infections

Topics: Child; Child, Preschool; Female; Humans; Infant; Iodohippuric Acid; Kidney Diseases; Male; Organometallic Compounds; Radioisotope Renography; Succimer; Sulfhydryl Compounds; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections

Topics: Child; Child, Preschool; Female; Humans; Hypertension, Renal; Infant; Kidney; Kidney Function Tests; Male; Pentetic Acid; Radiation Dosage; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pentetate; Urinary Bladder; Urinary Tract Infections; Vesico-Ureteral Reflux

Topics: Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Male; Pentetic Acid; Radionuclide Imaging; Succimer; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pentetate; Ultrasonography; Urinary Tract; Urinary Tract Infections; Urography

Combined [99mTc]DMSA kidney scintigraphy and [131I]hippuran renography were performed consecutively in 87 children with recurrent urinary tract infections in a retrospective study. This procedure allows a description of renal cortical morphology, split function determination and run-off evaluation. Signs of cortical scarring were found in 41 of 172 kidneys (24%) and were significantly associated with vesico-ureteral reflux (p less than 0.001) and with delayed urinary run-off (p less than 0.01). Split renal function was significantly reduced in kidneys with unilateral scarring (p less than 0.001). The radio-isotope investigations and intravenous urography were performed within 3 months of each other in 56 patients (110 kidneys). Good agreement between the findings was found except for 13 kidneys, where cortical activity defects were revealed by scintiscan despite normal urography. The extended scintigraphic procedure described is considered useful for urological screening of children with urinary tract infections and may thus replace urography as a first-line investigation. It should be followed by micturition cysto-urethrography when evaluation for vesico-ureteral reflux is indicated.

Topics: Adolescent; Child; Child, Preschool; Female; Hippurates; Humans; Infant; Kidney; Kidney Cortex; Kidney Diseases; Male; Radioisotope Renography; Succimer; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections; Urography

Topics: Adult; Female; Humans; Kidney; Ovary; Radionuclide Imaging; Recurrence; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections; Veins

Major advances in nuclear medicine instrumentation and radiopharmaceuticals for renal studies have occurred during the last decade. Current nuclear medicine methodology can be applied for accurate evaluation of renal function and for renal imaging in a wide variety of clinical situations. Total renal function can be estimated from the plasma clearance of agents excreted by glomerular filtration or tubular secretion, and individual function can be estimated by imaging combined with renography. A major area of radionuclide application is in the evaluation of obstructive uropathy. The introduction of diuretic renography and the use of computer-generated regions of interest offer the clinician added useful data which may aid in diagnosis and management. Imaging is of proven value also in trauma, renovascular hypertension, and acute and chronic renal failure. Methods for the evaluation of residual urine, vesicoureteral reflux, and testicular torsion have achieved increasing clinical use. These many procedures assure a meaningful and useful role for the application of nuclear medicine in genitourinary imaging.

Topics: Adult; Female; Humans; Infant; Iodohippuric Acid; Kidney Failure, Chronic; Male; Middle Aged; Organotechnetium Compounds; Pentetic Acid; Radioisotope Renography; Spermatic Cord Torsion; Succimer; Sugar Acids; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pentetate; Ureteral Obstruction; Urinary Tract Infections; Urologic Diseases; Vesico-Ureteral Reflux

Topics: Africa; Africa, Western; Antimony; Child; Drug Therapy; Humans; Organometallic Compounds; Schistosomiasis; Schistosomiasis haematobia; Succimer; Urinary Tract Infections

Topics: Antimony; Organometallic Compounds; Schistosomiasis; Schistosomiasis haematobia; Succimer; Urinary Tract Infections

Topics: Antimony; Humans; Iraq; Organometallic Compounds; Schistosomiasis; Schistosomiasis haematobia; Succimer; Urinary Tract Infections

Topics: Antimony; Iraq; Lucanthone; Organometallic Compounds; Schistosomiasis; Schistosomiasis haematobia; Succimer; Urinary Tract Infections

Topics: Antimony; Humans; Organometallic Compounds; Schistosomiasis; Schistosomiasis haematobia; Somalia; Succimer; Urinary Tract Infections