Decreased concentrating capacity in children with febrile urinary tract infection and normal 99mTc-dimercaptosuccinic ac
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Decreased concentrating capacity in children with febrile urinary tract infection and normal 99mTcdimercaptosuccinic acid scan: does medullonephritis exist?
Canary Islands, Spain
Background: Although 99mTc-dimercaptosuccinic acid (DMSA) scan is considered the gold standard for the diagnosis of acute pyelonephritis (AP), sometimes it produces false results in children with clinical features of AP. There are no studies on the comparison of the sensitivity of DMSA and concentrating capacity test. Methods: Eighty-five infants with AP of less than one year old were studied to evaluate whether they had real AP or not. Data were compared between infants with an abnormal (group A, n=64) and those with a normal DMSA scan (group B, n=21) respectively. A DDAVP test was performed for each infant. Results: All the infants in both groups presented a high level of C-reactive protein and fever (≥38ºC). There were no differences in clinical and analytical variables except C-reactive protein level in the two groups. Both groups exhibited a low urinary osmolality (87.5% in the group A vs. 85.7% in the group B). The patients with normal DMSA and decreased concentrating capacity have some renal parenchymal damage and not only a lower urinary infection. Of the infants with an abnormal DMSA scan, 33.9% showed renal scars after 6-12 months. No infant with a normal DMSA scan showed scars. The biochemical variables in both groups of infants were not
Author Affiliations: Pediatric Nephrology Section, "Nuestra Señora de la Candelaria" University Hospital, Santa Cruz de Tenerife, Canary Islands, Spain (García-Nieto V, González-Cerrato S, Luis-Yanes MI, MongeZamorano M, Reyes-Millán B) Corresponding Author: Víctor García-Nieto, MD, Pediatric Nephrology Section, "Nuestra Señora de la Candelaria" University Hospital, Carretera del Rosario, 145 38010-Santa Cruz de Tenerife, Canary Islands, Spain (Email: [email protected]) doi: 10.1007/s12519-014-0482-0 ©Children's Hospital, Zhejiang University School of Medicine, China and Springer-Verlag Berlin Heidelberg 2014. All rights reserved.
World J Pediatr, Vol 10 No 2 . May 15, 2014 . www.wjpch.com
related to vesicoureteral reflux. Conclusion: Infants with AP, normal DMSA scan and low concentrating capacity may be characterized by a localized infection in the medulla (medullonephritis) or by a false negative DMSA scan. World J Pediatr 2014;10(2):133-137 Key words: concentrating capacity; infants; pyelonephritis; urinary tract infection
Introduction
U
rinary tract infection (UTI) was considered until the 1930s as a primitive infection of the renal pelvis per se, with a secondary injury of the renal parenchyma.[1] In the thirties, it was proved "that the primary focus of infection is in the kidney itself ", [2] which is why the disease was called acute pyelonephritis (AP). Febrile UTI started to be successfully treated with the use of the first antibiotics and biochemical tests were specially designed to distinguish between lower UTI and AP. In addition to fever, these tests were performed in
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