Korean Journal of Nephrology 1996;15(4):514-518.

5세 미만 소아의 급성신우신염 초기 99 Tc-dimercaptosuccinic acid (DMSA) 신스캔 소견

유경희 , 김창덕 , 류진숙 , 박영서

Abstract

Patients with acute pyelonephritis are logical can- didates for scarring, as acquired renal scars can result from necrosis and fibrosis associated witb acute inflammation of the renal cortex. Renal scar- ring is important because of its association with hypertension and renal impairment. Defects seen on early renal scans in children with urinary tract in- fections may represent acute inflammatory changes or established scars. We described the morphology of early renal cortical defects and studied the rela- tionship between the presence of the vesicoureteral reflux and the prevalence of early renal cortical defects in patients under the age of 5 years with urinary tract infections. We examined 62 patients under the age of 5 years who were admitted to the Pediatric Department of Asan Medical Center due to urinary tract infection from August 1993 to July 1995. They had first proved urinary tract infections as results of urine culture(colony count>10"/mL) and elevated erythrocyte sedimentation rates(>25mm/hr) All patients were imaged with Tc-DMSA renal scan within 5 days after the fever developed and voiding cystourethrography after the complete resolu- tion of acute pyelonephritis. Most cases were under the age of 2 years(55/62, 89%). Renal cortical de- fects existed in 31(50%) of 62 cases and 37 of 124 renal units. Morphology of renal defects was uni- focal in 24, multifocal in 11, and diffuse involvement in 2 renal units. Sites of cortical defects were mo- stly in the upper poles of the kidneys. Early cortical defects were present in 21(64%) of 33 cases with the vesicoureteral reflux, however they were present in 16(18%) of 91 cases without the reflux(p<0.05). But only 21(57%) kidneys had the vesicoureteral reflux and the remaining 16(43%) kidneys had no re- flux among the 37 kidneys with defects. Therefore we found the results that the prevalence of renal cortical defects was higher in the presence of the vesicoureteral reflux, but 43% of the renal cortical defects ocurred without the reflux. We concluded that the influence of the vesicoureteral reflux on the prevalence of renal cortical defects was smaller than previously known.