Resolution of cortical lesions on serial renal scans in children with acute pyelonephritis

• Published in: Pediatric radiology 2007-02, Vol.37 (2), p.153-158
• Main Authors: Agras, Koray, Ortapamuk, Hülya, Naldöken, Seniha, Tuncel, Altuğ, Atan, Ali
• Format: Article
• Language: English
• Subjects: Acute Disease; Acute Kidney Injury - diagnostic imaging; Child; Child, Preschool; Female; Humans; Image Enhancement - methods; Infant; Male; Pyelonephritis - diagnostic imaging; Radiography; Radioisotope Renography - methods; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Dimercaptosuccinic Acid - administration & dosage; Time Factors; Ultrasonography
• ISSN: 0301-0449; 1432-1998
• DOI: 10.1007/s00247-006-0362-4

The ideal time for distinguishing a renal scar from acute inflammatory lesions by renal DMSA scintigraphy remains controversial. To determine the time needed for resolution of lesions after acute pyelonephritis. A total of 105 children with acute pyelonephritis underwent renal sonography, voiding cystourethrography and baseline DMSA scintigraphy. Two subsequent scans were performed during the 6th and 12th months in patients with abnormal findings on the previous scan. The baseline DMSA scintigraphy revealed cortical lesions in 37 patients. At 6 months, 13 patients (38.2%) were found to have cortical lesions. At 12 months, 6 patients (17.6%) were found to have persistent renal cortical lesions. The resolution rates for lesions detected on the first scan were 61.8% and 82.4% on the 6- and 12-month scans, respectively. Vesicoureteric reflux, and bilaterality or multifocality were not relevant for resolution of lesions. Female gender seemed to be associated with a higher persistence rate. The renal cortical defects present at 6 months have a high rate of resolution later during follow-up. DMSA scintigraphy performed 12 months after the infection provides more reliable data regarding persistence of renal cortical lesions.