급성 요로감염 환아의 신장 반흔 예측요인 (Predictive Factors of Renal Scarring in Children with Acute Urinary Tract Infection) |
Author |
백준현, 박영하, 황성수, 전정수, 김성훈, 이성용, 정수교, |
Jun Hyun Baik, M.D., Young Ha Park, M.D., Sung Su Hwang, M.D., Jung Su Jeon,M.D.,Sung Hoon Kim, M.D., Seong Yong Lee, M.D., Soo Kyo Chung, M.D. |
Affiliation |
가톨릭대학교 의과대학 방사선과학교실 Department of Radiology and Nuclear Medicine, The Catholic University of Korea, Seoul, Korea |
Abstract |
Puorpose:The purpose of this study was to evaluate the usefulness of 99mTc DMSA scintigraphy on the
dignosis of a renal scar in children with urinary tract infections. Materials and Methods:Eighty three
patients were included in this study, who were diagnosed as the urinary tract infection on the basis of
symptom, urinalysis and urine culture. 99mTc DMSA scintigraphy and voiding cystoureterography were
performed within 7days before the treatment in all patients. We classified the scintigraphic findings as follow
s:1;a large hypoactive upper or lower pole. 2;a small hypoactive area. 3;single defect resulting in
localized deformity of the outlines. 4;deformed outlines in a small or normal sized kidney. 5;multiple
defects. 6;diffuse hypoactive kidney without regional impairment. Follow-up scintigraphy was done at least
6 months after the initial study. When the abnormality on the initial scintigraphy was not completely resolved
on the follow-up scan, the lesion was defined as containing a scar. Results:One hundred and fifteen
renal units of 166 units(69.3%) showed abnormal findings on the DMSA scintigraphy. 65 units(56.5%) was
diagnosed as containing renal scars on follow-up scintigraphies. Incidences of renal scar among renal units
showing pattern 3, 4 and 5 on the initial scan was 75%, 78% and 78%, respectively. Whereas many of renal
units showing 1, 2 and 6 pattern were recovered(65%, 76%, 50%). Sensitivity, specificity and accuracy of
pattern-based DMSA scintigraphic findings on the diagnosis of renal scar was 76.9%, 85.1% and 81.9%,
respectively. VUR was significantly associated with the renal scar when the initial DMSA shows
unrecoverable findings(pattern 3, 4, 5). Odds ratio of the renal scar in a kidney showing unrecoverable initial
scintigraphic findings was 19.1. Odds ratio in a kidney with mild or moderate-to-severe VUR was 3.5 and
14.4 respectively. Conclusion:In the urinary tract infection, renal scar was significantly developed in a
kidney showing unrecoverable findings on the initial DMSA scan and VUR on voiding cystoureterography.
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Keyword |
urinary tract infection, Tc-99m DMSA, renal scarring, vesicoureteral reflux |
Full text Article |
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