Cortical scintigraphy in the evaluation of renal parenchymal changes in children with pyelonephritis,☆☆,

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Abstract

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. (J PEDIATR 1994;124:17-20)

Section snippets

METHODS

One hundred eleven patients (60 boys, 51 girls) 1 week to 16 years of age (median age 5.5 months) were included in the study between November 1987 and December 1992. They were hospitalized with the diagnosis of pyelonephritis, defined as follows: fever, with a temperature >38.5° C; abdominal pain in older children; general signs such as irritability, vomiting, feeding problems, or failure to thrive in children less than 1 year of age; ESR >20 mm/hr or CRP level >10 mg/L; and a positive urine

RESULTS

In the whole group of patients, 81 (73%) had renal lesions; CS showed changes in 86 kidneys (44 left and 42 right) of 74 children (67%), and US showed changes in 50 kidneys (24 left and 26 right) of 39 children (35%) (p < 0.001). Overall, results of the two examinations were discordant in 72 of the 104 involved kidneys (49 patients) (kappa = 0.19). Topographic analysis of the 131 focal lesions showed that 41% were localized to the upper poles, 28% to the middle third, and 31% to the lower poles

DISCUSSION

Pyelonephritis is usually diagnosed on the basis of clinical signs and a positive urine culture result. No laboratory or radiologic examination is available as a "gold standard" for diagnosis. Studies of experimentally induced pyelonephritis in piglets and rats have shown that renal scar formation is due to the inflammatory process (i.e., the initial infiltrate with polymorphonuclear leukocytes in response to the bacterial load).18, 19, 20 Cortical scintigraphy has been compared with

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    From the Departments of Pediatrics, Radiology, and Informatic, Hôpital Cantonal Universitaire de Genève, Geneva, Switzerland

    ☆☆

    Reprint requests: Daivy Benador, MD, Department of Pediatrics, 30, Boulevard de la Cluse, CH-1211 Geneva 14, Switzerland.

    0022-3476/94/$1.00 + .10 9/20/50494

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