ISSN:
1432-198X
Keywords:
Acute pyelonephritis
;
99mTechnetium-dimercaptosuccinic acid scintigraphy
;
Ultrasonography
;
UrineN-acetyl-β-d-glucosaminidase
;
Urine albumin
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Notes:
Abstract The diagnostic value of99mtechnetium-dimercaptosuccinic acid (DMSA) scintigraphy, ultrasonography and renal functional parameters [urineN-acetyl-β-d-glucosaminidase (NAG)/creatinine and urine albumin/creatinine quotients] in acute pyelonephritis (APN) were studied in 39 children (28 girls, 11 boys, median age 9 months, range 2 weeks to 9.4 years, 28 patients 〈1 year, 11 patients 〉1 year) with first-time urinary tract infection. Ultrasonography of the urinary tract was performed on admission and together with DMSA scintigraphy (〈10 days from admission). Urine NAG/creatinine and urine albumin/creatinine quotients were measured daily and after 6–8 weeks. Ultrasonography revealed abnormalities in 12 of 39 (31%) patients [11/32 patients (34%) with positive DMSA scintigraphy], while DMSA uptake defects were present in 32 of 39 (82%) patients [21/28〈1 year (75%), 11/11 〉1 year (100%),P=0.08]. Urine NAG/creatinine and urine albumin/creatinine quotients were significantly higher in children 〈1 year with APN, as well as in non-renal fever controls, than in older children. However, in both age groups the urine NAG/creatinine and urine albumin/creatinine quotients were significantly higher in APN than in non-renal fever. The urine NAG and albumin excretion decreased rapidly after the initiation of antimicrobial therapy and had normalized at 6–8 weeks. The size and grade of the DMSA uptake defect (DMSA score) did not correlate with duration of disease at admission, maximum C-reactive protein or maximum fever. The urine NAG/creatinine quotient in the children 〈1 year showed, however, a significant correlation with the DMSA score (r=0.58,P〈0.05), while no correlation was found in the older children. We conclude that DMSA scintigraphy is a sensitive method to confirm the clinical diagnosis of APN, although a substantial number of infants appear to have normal scans. Early determination of the urine NAG/creatinine and albumin/creatinine quotients may further improve the diagnostics in the infant.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1007/BF00869092
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