Elsevier

The Journal of Pediatrics

Volume 129, Issue 6, December 1996, Pages 815-820
The Journal of Pediatrics

Renal damage one year after first urinary tract infection: Role of dimercaptosuccinic acid scintigraphy,☆☆,,★★

https://doi.org/10.1016/S0022-3476(96)70024-0Get rights and content

Abstract

OBJECTIVE: 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. DESIGN: 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° 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. RESULTS: 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. CONCLUSION: 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. (J Pediatr 1996;129:815-20)

Section snippets

METHODS

During a 2-year period all children from birth to age 6 years who were treated at the Children's Hospital because of culture-verified acute first-time symptomatic UTI underwent DMSA scintigraphy in association with the infection and after 1 year. A body temperature of 38.5° C or higher was required for inclusion of children aged more than 1 year, whereas younger children were included irrespective of body temperature. Children with urinary tract obstruction were excluded. One hundred

RESULTS

The results of DMSA scintigraphy 1 year after the index UTI were abnormal in 59 (38%), equivocal in 33 (21%) and normal in 65 (41%) of the children. Bilateral abnormalities were found in 6 (10%) of the 59 children; 20 (34%) of the 59 children had an abnormal split renal function.

DISCUSSION

A major clinical problem in children with UTI is the difficulty of identifying those at risk of having renal damage. We previously demonstrated the diagnostic value of various clinical and laboratory variables in the identification of renal involvement in acute UTI.10 Little is known, however, about the value of these variables in identifying patients at risk of permanent scintigraphic renal damage. We therefore studied the importance of age at infection, body temperature, CRP concentration,

Acknowledgements

Statistical analyses were performed by Anders Odén, PhD.

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    From the Departments of Pediatric Radiology, Pediatrics, and Pediatric Clinical Physiology, East Hospital, and the Department of Radiology, Sahlgrenska Hospital, Göteborg University, Göteborg, Sweden

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    Supported by grants from the Göteborg Medical Society, the First of May Flower Annual Campaign for Children's Health, the Medical Faculty of Göteborg University, the Swedish Medical Research Council, and the Swedish Society for Medical Research.

    Reprint requests: Eira Stokland, MD, PhD, Department of Pediatric Radiology, Children's Hospital, East Hospital, 416 85 Göteborg, Sweden.

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    0022-3476/96/$5.00 + 0 9/21/76243

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