Normal Dimercaptosuccinic Acid Scintigraphy Makes Voiding Cystourethrography Unnecessary after Urinary Tract Infection

Preda, Iulian; Jodal, Ulf; Sixt, Rune; Stokland, Eira; Hansson, Sverker

doi:10.1016/j.jpeds.2007.05.008

« Previous Next »The Journal of Pediatrics
Volume 151, Issue 6 , Pages 581-584.e1, December 2007

Normal Dimercaptosuccinic Acid Scintigraphy Makes Voiding Cystourethrography Unnecessary after Urinary Tract Infection

Iulian Preda, MD
- Department of Pediatrics, The Queen Silvia Children’s Hospital, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden
Ulf Jodal, MD, PhD
- Department of Pediatrics, The Queen Silvia Children’s Hospital, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden
Rune Sixt, MD, PhD
- Department of Pediatric Clinical Physiology, The Queen Silvia Children’s Hospital, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden
Eira Stokland, MD, PhD
- Department of Pediatric Radiology, The Queen Silvia Children’s Hospital, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden.
Sverker Hansson, MD, PhD
- Department of Pediatrics, The Queen Silvia Children’s Hospital, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden
- Reprint requests: Sverker Hansson, The Queen Silvia Children’s Hospital, SE-416 85 Göteborg, Sweden.

Received 8 February 2007; received in revised form 10 April 2007; accepted 1 May 2007. published online 07 August 2007.

Objective

To test the hypothesis that infants with dilating vesicoureteral reflux (VUR) have abnormal acute dimercaptosuccinic acid (DMSA) scintigraphy results, as was suggested by an earlier retrospective study.

Study design

We conducted a prospective study of infants <1 year old with first diagnosed symptomatic urinary tract infection at the Children’s Hospital of Göteborg, Sweden. Two hundred ninety consecutive children (161 boys and 129 girls) with complete records were examined. Renal ultrasound scanning and DMSA scintigraphy were performed within a few days from diagnosis, and VCU was performed within 2 months.

Results

VUR was found in 52 children, of which 27 had dilating VUR (grade III-V). DMSA scintigraphy results were abnormal in 149 infants (51%), 105 of 238 (44%) without VUR, 18 of 25 (72%) with VUR grade I to II, and 26 of 27 (96%) with VUR grade III to V (P <.001).

Conclusion

DMSA scintigraphy results were abnormal in all 27 infants with dilating VUR except 1. This single false-negative finding should be compared with 140 unnecessary VCU investigations. This supports our hypothesis that DMSA scintigraphy results are abnormal when there is dilating VUR. Thus, a normal DMSA scan makes VCU unnecessary in the primary examination of infants with UTI.

Abbreviations: CRP, C-reactive protein, DMSA, Dimercaptosuccinic acid, MAG3, Mercaptoacetyltriglycine, US, Ultrasound scanning, UTI, Urinary tract infection, VCU, Voiding cystourethrography, VUR, Vesicoureteral reflux