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Prevalence of Acute Pyelonephritis and Renal Scar by Tc99m DMSA with Renal SPECT Imaging in Children with First Febrile Urinary Tract Infection
以DMSA核醫掃描評估兒童首次發燒的泌尿道感染所導致之急性腎盂腎炎及腎結痂的盛行率
並列摘要
Clinical signs and symptoms of urinary tract infection (UTO) are often nonspecific and misleading in pediatric patients, especially in infants. Technetium 99-m-dimercaptosuccinic acid (Tc99m DMSA) scintigraphy is considered the most sensitive technique for the identification of renal parenchymal change in acute pyelonephritis (APN) and renal scarring. But there is no accurate prevalence of APN in children with first febrile UTI. Our study is to investigate the prevalence of APN and renal scarring by means of DMSA renal SPECT image and the role of vesicoureteric reflux (VUR) in APN and renal scar formation for Children with febrile UTI. Form Nov. 1996 to Dec. 199,216 patients (132 boys and 84 girls) were enrolled into our study. Inclusion criteria for febrile UTI included fever with body temperature＞ 38ºC and positive urine culture. Recurrent UTI history and obstructive or congenital abnormalities of genitourinary tract, except VUR, were excluded. Scintigraphy was firstly performed within seven days of admission and scintigraphy was followed up at least 3 months later after the acute episode. Children were grouped by the different age as Gr. I: ＜ 1 yr (M/F: 113/36); Gr. II 1~5 yr (M/F: 11/22); and Gr. III: ＞ 5`17yr (M/F: 8/26). The overall prevalence of APN in febrile UTI was 70%(male: 66%, female: 76%, P = 0.110). Different age group with APN have significant difference (I:63%, II: 86%; III:84%, Gr. I vs II & vs III P＜0.05). During the follow-up period, 61 (46%) of 133 APN patients received secondary scintigraphy, and 35 (57%) patients showed renal scar formation. Totally, 106(M/F: 59/47) patients with febrile UTI received VCUS, and the prevalence of VUR in each age group were I: 22%; II: 68%, and III: 44% (Gr. I vs II, P ＜ 0.05). However, there were no significant different in gender. APN associated with VUR was 31% (24/78), and renal scar associated with VUR was 58% (14/24). By comparison of grading in VUR, we confirmed that high-graded (3-5) VUR was more susceptible to renal scar formation (P＜0.05) To conclude, our study revealed children with febrile UTI seem to have higher prevalence of APN than of infant (≤ 1 yr). There was significant difference of VUR in different age, esp. in children with febrile UTI. Low-graded VUR is not the risk for APN or renal scar formation, and the role of prophylactic antibiotics for low-graded VUR should be reevaluated.