Acute phase 99mTc-dimercaptosuccinic acid scan in infants with first episode of febrile urinary tract infection
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Acute phase 99mTc-dimercaptosuccinic acid scan in infants with first episode of febrile urinary tract infection Nikoleta Printza, Evagelia Farmaki, Kalliopi Piretzi, George Arsos, Konstantinos Kollios, Fotios Papachristou Thessaloniki, Greece
Original article
Background: 99mTc-dimercaptosuccinic acid (DMSA) scan is the golden standard for the diagnosis of acute pyelonephritis and renal scaring. We investigated the use of acute phase DMSA scan in infants presented promptly to the hospital because of the first episode of their febrile urinary tract infection (UTI).
Conclusions: Parenchymal damage found in a minority of infants with febrile UTI presented promptly to the hospital. Acute phase DMSA scan should be carried out only in selected patients. An abnormal acute DMSA scan is a moderate predictor for dilated VUR and its ability to exclude VUR is restricted.
Methods: Ninety-eight infants with microbiologically confirmed first episode of febrile UTI were studied. DMSA scans were carried out within 7 days in these infants after admission. Infants with an abnormal acute DMSA scan underwent a second DMSA scan 6-12 months later.
World J Pediatr 2012;8(1):52-56
Results: Overall, acute DMSA scan was abnormal in 16 (16.3%) of the 98 patients. There were no differences in sex, age, fever over 38.5°C, blood inflammation indices, or evidence of vesicoureteral reflux (VUR) between patients with normal and abnormal acute DMSA scan (P>0.05). However, infants with grade III to V VUR as well as those with delayed treatment presented significantly increased renal involvement by acute DMSA scan (P38.5°C Duration of fever ≤3 d >3 d
Normal acute Abnormal acute P DMSA scan (%) DMSA scan (%) 51 (62.2) 31 (37.8)
6 (37.5) 10 (62.5)
NS
52 (63.4) 30 (36.6)
8 (50.0) 8 (50.0)
NS
44 (53.6) 38 (46.4)
6 (37.5) 10 (62.5)
NS
73 (89.0) 9 (11.0)
9 (56.3) 7 (43.7)
0.010
DMSA: 99mTc-dimercaptosuccinic acid; NS: no significance.
World J Pediatr, Vol 8 No 1 . February 15, 2012 . www.wjpch.com
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Original article
Study population Ninety-eight infants consecutively admitted to our department with microbiologically confirmed first episode of febrile UTI were prospectively studied. The infants should be 1 to 12 months of age, with no earlier UTI or evidence of obstructive nephropathy in prenatal screening or other urogenital abnormalities. The infants were treated with antibiotics immediately after their urine and blood samples were collected. They were treated empirically with antimicrobial agents (amoxicillin + clavulanic acid, 2nd or 3rd generation cephalosporins) until organisms were identified and antimicrobial drug susceptibility was known. Treatment with antibiotics continued intravenously until the infants presented afebrile for 24 to 36 hours. A 10- to 14-day course of oral antibiotics was provided. The time between the onset of fever and the start of therapy was recorded. Infants with dilated VUR (grades III to V) shown by cyclic voiding cystourethrography received prophylactic therapy with trimethoprimesulfomethoxazole or 2
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