Child Kidney Dis.  2016 Oct;20(2):74-78. 10.3339/jkspn.2016.20.2.74.

Prognostic Factors of Renal Scarring on Follow-up DMSA Scan in Children with Acute Pyelonephritis

• Lee J
• Woo BW
• Kim HS

• KMID: 2366600
• DOI: http://doi.org/10.3339/jkspn.2016.20.2.74

Abstract

PURPOSE
Early diagnosis and treatment of urinary tract infection have been emphasized to prevent renal scarring. If untreated, acute pyelonephritis could cause renal injury, which leads to renal scarring, hypertension, proteinuria, and chronic renal failure. The purpose of this study was to assess risk factors of renal scarring after treatment of acute pyelonephritis (APN).
METHODS
The medical records of 59 patients admitted at Daegu Fatima Hospital because of APN between March 2008 and April 2015 whose renal cortical defects were confirmed by using initial technetium-99m dimercaptosuccinic acid (DMSA) scans were reviewed retrospectively. We divided 59 patients into 2 groups according to the presence of renal scar and assessed risk factors of renal scar, including sex, age at diagnosis, feeding method, hydronephrosis, bacterial species, vesicoureteral reflux, and vesicoureteral reflux grade.
RESULTS
Of 59 patients (41%), 24 showed renal scar on follow-up DMSA scan. No significant differences in sex, hydronephrosis, bacterial species, and fever duration were found between the renal-scarred and non-scarred groups. As for age at diagnosis, age of >12 months had 5.8 times higher incidence rate of renal scarring. Vesicoureteral reflux (VUR) affected renal scar formation. VUR grade III or IV had 14.7 times greater influence on renal scar formation than VUR grade I or II.
CONCLUSION
Our data suggest that the presence of VUR and its grade and age at diagnosis are risk factors of renal scar on follow-up DMSA scan after APN.

Keyword

Acute pyelonephritis; Renal scar

MeSH Terms

Child*
Cicatrix*
Daegu
Diagnosis
Early Diagnosis
Feeding Methods
Fever
Follow-Up Studies*
Humans
Hydronephrosis
Hypertension
Incidence
Kidney Failure, Chronic
Medical Records
Proteinuria
Pyelonephritis*
Retrospective Studies
Risk Factors
Succimer*
Urinary Tract Infections
Vesico-Ureteral Reflux
Succimer