TY - JOUR T1 - Vezikoüreteral reflülü çocuklarda anormal dimercaptosüksinik asit (DMSA) renal tarama bulguları ile ilişkili faktörler TT - Factors associated with abnormal dimercaptosuccinic acid (DMSA) renal scan findings in children with vesicoureteral reflux AU - Önal, Hülya Gözde AU - Semet, Yonca PY - 2024 DA - September Y2 - 2024 DO - 10.18663/tjcl.1548755 JF - Turkish Journal of Clinics and Laboratory JO - TJCL PB - DNT Ortadoğu Yayıncılık A.Ş. WT - DergiPark SN - 2149-8296 SP - 488 EP - 493 VL - 15 IS - 3 LA - tr AB - Amaç: Bu çalışmada, vezikoüreteral reflü (VUR) tanısı almış çocuklarda anormal dimercaptosüksinik asit (DMSA) tarama sonuçları ile demografik faktörler, VUR şiddeti ve lateralitesine ek olarak idrar yolu enfeksiyonu (İYE) varlığı arasındaki ilişkinin araştırılması amaçlandı.Gereç ve Yöntemler: VUR tanısı alan 39 çocuk üzerinde retrospektif bir analiz yapıldı. Veriler, yaş, cinsiyet, VUR derecesi, bilateral VUR varlığı ve İYE sıklığını içeriyordu. DMSA taramaları böbrek skarlarını değerlendirmek için kullanıldı. Anormal ve normal DMSA sonuçları olan hastalar arasında istatistiksel karşılaştırmalar yapıldı.Bulgular: Çocukların ortalama yaşı 30 ay olup, %82’si kızlardan oluşmaktaydı. VUR derecesi III ve üzeri olan hastalarda anormal DMSA bulguları anlamlı şekilde daha yüksek bulundu (%81,5’e karşı %50, p = 0,046). Ancak, gruplar arasında bilateral VUR sıklığı açısından anlamlı bir fark bulunmadı (%33,3’e karşı %41,7, p = 0,618). Anormal DMSA bulguları olan hastalarda İYE sıklığı daha yüksek olmasına rağmen, bu fark istatistiksel olarak anlamlı değildi (%63,0’a karşı %33,3, p = 0,090).Sonuç: Yüksek VUR dereceleri anormal DMSA sonuçları ile anlamlı bir ilişki göstermektedir. Ancak, bilateral VUR veya İYE sıklığı ile istatistiksel olarak anlamlı bir ilişki gözlenmemiştir. Bulgular, böbrek hasarının ana belirleyicisinin VUR şiddeti olabileceğini göstermektedir. KW - vezikoüreteral reflü KW - dimercaptosüksinik asit taraması KW - idrar yolu enfeksiyonları KW - böbrek skarı N2 - Aim: This study aimed to investigate the association between abnormal dimercaptosuccinic acid (DMSA) scan results and demographic factors, vesicoureteral reflux (VUR) severity and laterality, as well as the presence of urinary tract infections (UTIs) in children diagnosed with VUR.Material and Methods: A retrospective analysis was conducted on 39 children diagnosed with VUR. Data included age, gender, VUR grade, the presence of bilateral VUR, and UTI frequency. DMSA scans were used to assess renal scarring. Statistical comparisons were made between patients with normal and abnormal DMSA results to identify significant predictors of renal damage.Results: The mean age of the children was 30 months, with 82% being female. VUR Grade III and above was significantly associated with abnormal DMSA findings (81.5% vs. 50%, p = 0.046). However, no significant difference was observed in the frequency of bilateral VUR between groups (33.3% vs. 41.7%, p = 0.618). Although patients with abnormal DMSA findings had a higher incidence of UTIs, this difference was not statistically significant (63.0% vs. 33.3%, p = 0.090).Conclusion: While higher VUR grades were related to abnormal DMSA results, there was no significant statistical association with bilateral VUR or UTIs. These findings suggest that the severity of VUR may be a more important predictor of kidney damage. CR - Walawender L, Becknell B, and Matsell DG. Congenital anomalies of the kidney and urinary tract: defining risk factors of disease progression and determinants of outcomes. Pediatr Nephrol. 2023;38(12):3963-73. DOI: 10.1007/s00467-023-05899-w. CR - Hofmann AD, Duess JW, and Puri P. Congenital anomalies of the kidney and urinary tract (CAKUT) associated with Hirschsprung's disease: a systematic review. Pediatr Surg Int. 2014;30(8):757-61. DOI: 10.1007/s00383-014-3529-3. CR - Ishikura K, Uemura O, Hamasaki Y, et al. Insignificant impact of VUR on the progression of CKD in children with CAKUT. Pediatr Nephrol. 2016;31(1):105-12. DOI: 10.1007/s00467-015-3196-1. CR - Fang ZX and Eger EI, 2nd. Factors affecting the concentration of compound A resulting from the degradation of sevoflurane by soda lime and Baralyme in a standard anesthetic circuit. Anesth Analg. 1995;81(3):564-8. DOI: 10.1097/00000539-199509000-00025. CR - Mattoo TK. Vesicoureteral reflux and reflux nephropathy. Adv Chronic Kidney Dis. 2011;18(5):348-54. DOI: 10.1053/j.ackd.2011.07.006. CR - Chang JW, Liu CS, and Tsai HL. Vesicoureteral Reflux in Children with Urinary Tract Infections in the Inpatient Setting in Taiwan. Clin Epidemiol. 2022;14:299-307. DOI: 10.2147/CLEP.S346645. CR - Lackgren G, Cooper CS, Neveus T, and Kirsch AJ. Management of Vesicoureteral Reflux: What Have We Learned Over the Last 20 Years? Front Pediatr. 2021;9:650326. DOI: 10.3389/fped.2021.650326. CR - Shaikh N, Spingarn RB, and Hum SW. Dimercaptosuccinic acid scan or ultrasound in screening for vesicoureteral reflux among children with urinary tract infections. Cochrane Database Syst Rev. 2016;7(7):CD010657. DOI: 10.1002/14651858.CD010657.pub2. CR - Roupakias S, Sinopidis X, Tsikopoulos G, Spyridakis I, Karatza A, and Varvarigou A. Dimercaptosuccinic acid scan challenges in childhood urinary tract infection, vesicoureteral reflux and renal scarring investigation and management. Minerva Urol Nefrol. 2017;69(2):144-52. DOI: 10.23736/S0393-2249.16.02509-1. CR - Harper L, Lefevre Y, Delforge X, Bourquard D, and Ferdynus C. Children with abnormal DMSA nuclear scan present a higher risk of recurrent febrile urinary tract infections. World J Pediatr. 2019;15(2):204-05. DOI: 10.1007/s12519-018-0152-8. CR - Araujo CB, Barroso U, Jr., Barroso VA, et al. Comparative study between intravenous urography and renal scintigraphy with DMSA for the diagnosis of renal scars in children with vesicoureteral reflux. Int Braz J Urol. 2003;29(6):535-9. DOI: 10.1590/s1677-55382003000600011. CR - Ergun R, Sekerci CA, Tanidir Y, et al. Abnormal DMSA renal scan findings and associated factors in older children with vesicoureteral reflux. Int Urol Nephrol. 2021;53(10):1963-68. DOI: 10.1007/s11255-021-02934-3. CR - Elmacı AM and Akın F. Konjenital böbrek ve üriner kanal anomalisi bulunan çocukların klinik ve demografik özellikleri. Dicle Tıp Dergisi. 2014;41(2):309-12. CR - Yavuz S, Kıyak A, Demir F, and Akınel AN. Renal ektopili çocukların ürolojik ve nefrolojik analizi. Dicle Tıp Dergisi. 2014;41(3):529-33. CR - Azılı MN, Çalışkan D, Kabacam GB, Tiryaki T, and Atayurt H. May DMSA Findings Be Predictive Of Sting Procedure Failure In Children With Primary Vesicoureteral Reflux?(An Evaluation Of 132 Cases). Turkish Journal of Pediatric Disease. 5(4):240-45. CR - Balestracci A, Montecuco M, Serviddio C, et al. Role of Late DMSA Renal Scan in Detecting High-Grade Vesicoureteral Reflux. Indian J Pediatr. 2019;86(9):784-89. DOI: 10.1007/s12098-019-02917-4. CR - Capozza N, Gulia C, Heidari Bateni Z, et al. Vesicoureteral reflux in infants: what do we know about the gender prevalence by age? Eur Rev Med Pharmacol Sci. 2017;21(23):5321-29. DOI: 10.26355/eurrev_201712_13916. CR - Blumenthal I. Vesicoureteric reflux and urinary tract infection in children. Postgrad Med J. 2006;82(963):31-5. DOI: 10.1136/pgmj.2005.036327. CR - Stefanidis CJ and Siomou E. Imaging strategies for vesicoureteral reflux diagnosis. Pediatr Nephrol. 2007;22(7):937-47. DOI: 10.1007/s00467-006-0396-8. CR - Tekgul S, Riedmiller H, Hoebeke P, et al. EAU guidelines on vesicoureteral reflux in children. Eur Urol. 2012;62(3):534-42. DOI: 10.1016/j.eururo.2012.05.059. CR - Dogan CS, Koyun NS, Aksoy GK, Cekic B, Savas M, and Comak E. Delayed diagnosis of primary vesicoureteral reflux in children with recurrent urinary tract infections: Diagnostic approach and renal outcomes. Turk J Urol. 2018;44(6):498-502. DOI: 10.5152/tud.2018.98372. CR - Mattoo TK, Chesney RW, Greenfield SP, et al. Renal Scarring in the Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) Trial. Clin J Am Soc Nephrol. 2016;11(1):54-61. DOI: 10.2215/CJN.05210515. CR - Aboutaleb H, Abouelgreed TA, El-Hagrasi H, Bakry Eldib D, Abdelaal MA, and El Gohary MA. Correlation of Renal Scarring to Urinary Tract Infections and Vesicoureteral Reflux in Children. Adv Urol. 2022;2022:9697931. DOI: 10.1155/2022/9697931. CR - Tasolar SD, Sigirci A, Dogan GM, et al. Evaluation of the relationship of the time of vesicoureteral reflux between renal scar development and endoscopic treatment success in early childhood. Ann Med Res. 2022;29(8):874-78. CR - Siomou E, Giapros V, Fotopoulos A, et al. Implications of 99mTc-DMSA scintigraphy performed during urinary tract infection in neonates. Pediatrics. 2009;124(3):881-87. CR - Park YS. Renal scar formation after urinary tract infection in children. Korean journal of pediatrics. 2012;55(10):367. CR - Park YS. Renal scar formation after urinary tract infection in children. Korean J Pediatr. 2012;55(10):367-70. DOI: 10.3345/kjp.2012.55.10.367. CR - Horsager TH, Hagstrøm S, Skals R, and Winding L. Renal scars in children with febrile urinary tract infection-Looking for associated factors. Journal of Pediatric Urology. 2022;18(5):682. e1-82. e9. CR - Su D, Zhuo Z, Zhang J, Zhan Z, and Huang H. Risk factors for new renal scarring in children with vesicoureteral reflux receiving continuous antibiotic prophylaxis. Sci Rep. 2024;14(1):1784. DOI: 10.1038/s41598-024-52161-w. UR - https://doi.org/10.18663/tjcl.1548755 L1 - https://dergipark.org.tr/tr/download/article-file/4208493 ER -