Çocuklarda akut piyelonefrit ve böbrek parankim zedelenmesinde MAG3 sintigrafinin ve DMSA sintigrafinin tanısal değeri

Year 2016, Volume: 41 Issue: 3, 464 - 471, 30.09.2016

Buket Kılıçaslan Handan Alp Mustafa Yıldırım Tacettin İnandı

https://doi.org/10.17826/cukmedj.237484

Cited By: 1

Abstract

Amaç: Çalışmamızda, bulgu veren ilk idrar yolu enfeksiyonu olan çocuklarda akut piyelonefrit ve böbrek parankim zedelenmesinde MAG3 sintigrafinin tanısal değeri ve DMSA sintigrafi ile karşılaştırılması amaçlanmıştır. 

Gereç ve Yöntem: İdrar yolu enfeksiyonu düşündüren şikayetlerle başvuran, daha önce idrar yolu enfeksiyonu tanısı almamış, 70 hasta çalışma kapsamına alındı. Çalışmaya alınan tüm hastaların tedavisi yapılmadan önce, kan ve idrar örnekleri alınarak, lökosit sayısı, sedimentasyon hızı, C-reaktif protein konsantrasyonu saptandı. Böbrek parankim zedelenmesinin saptanmasında DMSA sintigrafi 'altın standart' tanı yöntemi kabul edildi. Bulgu veren ilk idrar yolu enfeksiyonu tanısı alan çocuklarda, böbrekte parankim zedelenmesini saptamada MAG3 sintigrafinin duyarlılık, seçicilik, pozitif ve negatif kestirim değeri saptandı. 

Bulgular: Çalışmamızın sonucunda, piyelonefrit ve sistitli olgularımızın ayrımında ateş, lökosit, C-reaktif protein ve sedimentasyon yüksekliği istatistiksel olarak oldukça anlamlı bulundu; ancak, bu değerlerin, DMSA sintigrafide saptanan parankim zedelenmesinin şiddetini göstermede istatistiksel olarak anlamlılık taşımadığı saptandı. Böbrek parankim zedelenmesini göstermede, MAG3 sintigrafinin duyarlılığı % 32,5, seçiciliği ise % 98,1 saptandı. 

Sonuç: Çocuklarda, MAG3 sintigrafinin böbrek parankim zedelenmesini belirlemede DMSA sintigrafinin yerini alamayacağı kanısına varıldı.

Keywords

Piyelonefrit, MAG3, DMSA, sintigraf

Diagnostic value of MAG3 scintigraphy and DMSA scintigraphy in renal parenchyma damage and acute pyelonephritis of children

Abstract

Purpose: In this study, we aimed to compare diagnostic value of MAG3 scintigraphy in renal parenchyma damage and acute pyelonephritis, in the first urinary tract infection in children, with DMSA scintigraphy. 

Material and Methods: Seventy patients who never diagnosed before but admitted with complaints of urinary tract infection for the first time, were included in this study. Before the treatment of all patients in the study were taken blood and urine samples, and leukocyte count, erythrocyte sedimentation rate, C-reactive protein concentration were determined. DMSA scintigraphy in detection of renal parenchyma damage was accepted as "gold standard". In the detection of damage in renal parenchyma, positive and negative predictive value, selectivity and sensitivity of MAG3 scintigraphy were detected.

Results: The fever, elevated leukocytes, C-reactive protein and sedimentation rate were found statistically significant in the detection of pyelonephritis. However, these values were not significant statistically in the demonstration of the severity of parenchyma damage. In the detection of damage in renal parenchyma, MAG3 scintigraphy had a sensitivity of 32.5 % and a specificity of 98.1 %.  

Conclusion: MAG3 scintigraphy can not replace DMSA scan to determine the renal parenchyma damage in childhood.

Keywords

Pyelonephritis, MAG3, DMSA

References

• Ammenti A, Cataldi L, Chimenz R, Fanos V, La Manna A, Marra G et al. Febrile urinary tract infections in young children: recommendations for the diagnosis, treatment and follow-up. Acta Pediatr. 2012;101:451-7.
• Edefonti A, Tel F, Testa S, De Palma D. Febrile urinary tract infections: Clinical and laboratory diagnosis, imaging, and prognosis. Semin Nucl Med. 2014;44:123-8.
• MacNeily AE. Pediatric urinary tract infections: current controversies. Can J Urol. 2001;8:18-23.
• De Palma D, Manzoni G. Different imaging strategies in febrile urinary tract infection in childhood. What, when, why? Pediatr Radiol. 2013;43:436-43.
• La Scola C, De Mutiis C, Hewitt IK, Puccio G, Toffolo A, Zucchetta P et al. Different guidelines for imaging after first UTI in febrile infants: Yield, cost, and radiation. Pediatrics. 2013;131:665-7.
• Othman S, Al-Hawas A, Al-Maqtari R. Renal cortical imaging in children 99mTc MAG3 Versus 99mTc DMSA. Clin Nucl Med. 2012;37:351-5.
• Sobel JD and Kaye D. Urinary tract infections. In Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, Mandell GL, Bennett JE, and Dolin R (editors). 5th ed. New York: Churchill Livingstone. 2000:774-800.
• Hellerstein S. Urinary traet infections in children: pathophysiology, risk factors, and management. Infect Med. 2002;19:554-60.
• American Academy of Pediatrics. Practice parameter: The diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. Pediatrics. 1999;103:843-52.
• Fernandez-Menendez JM, Malaga S, Matesanz JL, Solıs G, Alonso S, Perez-Mendez C. Risk factors in the development of early technetium-99m dimercaptosuccinic acid renal scintigraphy lesions during first urinary tract infection in children. Acta Pediatr. 2003;92:21-6.
• Burbige KA, Retik AB, Colodny AH, Bauer SB, Lebowitz R. Urinary tract infections in boys. J Uro1. 1984;132:541-2.
• Brandström P, Esbjörner E, Herthelius M, Swerkersson S, Jodal U, Hansson S. The Swedish reflux trial in children: III. Urinary tract infection pattern. J Urol. 2010;184:286-91.
• Hoberman A, Wald ER. Treatment of urinary tract infection. Pediatr Infect Dis J. 1999;18:1020-1.
• Zaki M, Mutari GA, Badawi M, Ramadan D, AI deen Hanafy E. Vesicoureteric reflux in Kuwaiti children with first febrile urinary tract infection. Pediatr Nephrol. 2003;18:898-901.
• Prais D, Straussberg R, Avitzur Y, Nussinovitch M, Harel L, Amir J. Bacterial susceptibility to oral antibiotics in community acquired urinary tract infection. Arch Dis Child. 2003;88:215-8.
• Biggi A, Dardanelli L, Pomero G, Cussino P, Noello C, Sernia O. Acute renal cortical scintigraphy in children with a first urinary tract infection. Pediatr Nephrol. 2001;16:733-8.
• Sobel JD and Kaye D. Urinary tract infections. In Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, Mandell GL, Bennett JE, and Dolin R (editors). 6th ed. Philadelphia: Elsevier; 2005.875-901.
• Goldman M. Bistritzer T, Horne T. The etiology of renal scars in infants with pyelonephritis and vesieoureteral reflux. Pediatr Nephrol. 2000;14:385-8.
• Garin EH, Olavarria F, Araya C, Broussain M, Barrera C, Young L. Diagnostic significance of clinical and laboratory findings to localize site of urinary infection. Pediatr Nephrol. 2007;22:1002-6.
• Sfakianakis GN. Diuretic MAG3 scintigraphy (F0) in acute dysfunction and comparisan with DMSA. J Nucl Med. 2000;41:1955-63. regional parenehymal
• Puseljie S, Arambasic J, Gardasanic J, Milas V, Puseljic I, Sipl M. The value of Tc-99m-DMSA renal scintigraphy in evaluation severity of parenchymal lesions in children with acute urinary tract infection. Acta Med Croatica. 2003;57:5-10.
• Wald E. Urinary tract infections in infants and children: a comprehensive overview. Curr Opin Pediatr. 2004;16:85-8.
• Hansson S, Martineli J, Stokland E, Jodal U. The natural history of bacteriuria in childhood. Infect Dis Clin North Am. 1997;11:499-512.
• Sinha MD, Postlethwaite RJ. Urinary tract infections and the long-term risk of hypertension. Curr Pediatr. 2003;13:508-12.
• De Bruyn R, Gordon i, MeHugh K. Imaging of the kidneys and urinary tract in children. In Diagnostic Radiology, Grainger RG, Allison DJ, Adam A, Dixon AK (editors). 4th ed. Edinburg: Churchill Livingstone. 2001:1717-64.
• Hafez AT, McLorie G, Bagli D, Khoury A. Analysis of trends on serial ultrasound for high grade neonatal hydronephrosis. J Urol. 2002;168:1518-21.
• Conway JJ. 'Well-Tempered' diuresis renography: Its historical development, physiological and technical pitfalls, and standardized technique protocol. Semin Nuc Med. 1992;22:74-84.
• Yaylalı OT, Kıraç FS, Yüksel D. Performance of technetium-99m scintigraphy in evaluation of renal parenchymal lesions: A comparative study with technetium-99m
• mercaptoacetyltriglycine dimercaptosuccinic acid. Journal of Chinese Clinical Medicine. 2009;4:481-7.
• Otukesh H, Fereshtehnejad SM, Jalali A. Early detection of renal scarring in children with suspected pyelonephritis: Comparison of diuretic MAG3 scintigraphy (F0) and DMSA scan. Med J Islam Repub Iran. 2007;21:17-24.
• Gordon I, Anderson PJ, Lythgoe MF, Orton M. Can technetium-99m-mercaptoacetyltriglycine technetium-99mdimercaptosuccinic acid in the exclusion of a focal renal defect? J Nucl Med. 1992;33:2090-3. replace
• Abdulrezzak U, Erdoğan Z, Kula M. Evaluation of renal parenchymal defects with 99m technetium mercaptoacetyltriglycine modified grading and scoring system: comparison with 99m technetium dimercaptosuccinic acid. Erciyes Medical Journal. 2013;35:18-23. using a
• Tepmongkol S, Chotipanich C, Sirisalipoeh S, Chaiwatanarat T, Vilaiehon AO, Wattana D. Relationship between vesicoureteral reflux and renal cortical scar development in Thai children: The significance of renal cortical scintigraphy and direct radionuclide cystography. J Med Assoc Thai. 2002;85:203-9.
• Macedo CS, Riyuza MC, Bastos HD. Renal scars in children with primary vesicoureteral reflux. J Pediatr (Rio J). 2003;79:355-62.
• Hiraoka M, Hashimoto G, Tsuchida S, Tsukahara H, Ohshima Y, Mayumi M. Early treatment of urinary infection prevents renal damage of cortical scintigraphy. Pediatr Nephrol. 2003;18:115-8.
• Jakobsson B, Soderlundh S, Berg U. Diagnostic significance of 99m-Tc- dimercaptosuccinicacid (DMSA) scintigraphy in urinary tract infection. Arch Dis Child. 1992;67:1338-42.
• Smellie JM, Poulton A, Prescod NP. Retrospective study of children with renal scarring associated with reflux and urinary infection. BMJ. 1994;308:1193-6.