Necessity of (99m)Tc-dimercaptosuccinic acid scan in infants with low grade vesicoureteral feflux

Koh, Ji Yeon; Koo, Ja Wook

Abstract

OBJECTIVE
(99m)Tc-dimercaptosuccinic acid(DMSA) scan is considered to be the most sensitive examination for detection of renal scars. However, because of its high radiation exposure to the kidney and its limited usefulness for patients with low grade vesicoureteral reflux(VUR), some authors have suggested that DMSA scans should be reserved primarily for children with VUR grade 3 and above. The aim of this study was to reevaluate the necessity of DMSA scans as a screening test in infants without reflux or with low grade reflux.
METHODS
In this retrospective study, 189 infants(mean age:6.2 months) diagnosed as UTI were enrolled. Voiding cystourethrogram(VCUG), DMSA scan and renal ultrasonography were performed within 1 month of UTI. VUR grade was classified into three subgroups; low grade(grade 1-2), moderate grade(grade 3), and high grade(grade 4-5), respectively.
RESULTS
Renal defects were present in 67 of 189 infants, and 82 of the 378 renal units. The incidence of renal defects was significantly correlated with VUR grade(P<0.01); 28 percent without reflux, 38 percent with low grade, 53 percent with moderate grade, 100 percent with high grade, respectively. However, there was no significant differences in incidence of renal defects between the low grade and moderate grade group.
CONCLUSION
In this study, renal defects were found in quite high percentages; 28 percent patients without reflux and 38 percent patients with low grade VUR, respectively. Moreover, there was no significant difference in the incidence of renal defects between the low grade and moderate grade groups. Therefore, DMSA scan should be performed for infants with UTI as a screening test regardless of the presence of VUR.