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Category: Volume 09 Issue 02 February 2021
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Title: Comparison of Renal Ultrasonography and Technetium 99-M Dimercaptosuccinic acid Renal Cortical Scintigraphy in Identifying Renal Parenchymal Defects in Febrile Urinary Tract Infection In Children Less than Five Years Age

Authors: Dr S.Thiyaneshwaran, Dr K Rajendran, Dr K.K. Kamaleshwaran

 DOI: https://dx.doi.org/10.18535/jmscr/v9i2.37

Abstract

Background: UTIs are common infections that happen when bacteria, often from the skin or rectum, enter the urethra and infect the urinary tract. The infections can affect several parts of the urinary tract, but the most common type is a bladder infection (cystitis). Dimercaptosuccinic acid (DMSA) scintigraphy is the gold standard in the evaluation of renal parenchymal defects and is widely used in the pediatric population. As more recent ultrasound equipment was purchased at our tertiary pediatric center, our objective was to evaluate if renal ultrasound (US) results are equivalent or sufficient when compared to DMSA scintigraphy in the assessment of renal anomalies.

Aim and Objective: To find out whether renal ultrasonography or dimercaptosuccinic acid renal scintigraphy can be used as the first imaging modality after a case of febrile Urinary tract infection in children less than 5 years of age.

Methods: this prospective observational study was conducted in the Pediatric department of KMCH, Coimbatore from MAY 2019 – DECEMBER 2019. . 90 children with culture-proven febrile Urinary tract infection from the department of pediatrics KMCH will be included in the study to compare technetium-99m DimercaptoSuccinic Acid renal cortical scintigraphy and Ultrasound KUB in detecting renal parenchymal defects in Febrile Urinary tract infection in children.

Results: In our study out of 90 children 53.3% were males and 46.7% were female. All children included in this study were significant Urine Culture Positive. The most common organism isolated in urine culture was E. coli followed by Klebsiella. In our study, the sensitivity and specificity of USG KUB in detecting Renal parenchymal abnormalities in comparison with DMSA is 12 % and 95.4 % respectively. And the positive predictive value of USGKUB is 50% and the negative predictive value is 73.8 % in detecting parenchymal defects in children when compared to DMSA.

Conclusion: It is observed from our study that although ultrasonography has a good specificity in the detection of renal parenchymal defects when compared with DMSA, it has low sensitivity, positive predictive value, and negative predictive value. Thus we conclude that at present Ultrasonography cannot be substituted for DMSA in identifying renal parenchymal defects in children with Febrile UTI. Dimercaptosuccinic acid scan done at presentation identifies children with acute pyelonephritis and at six months later identify those children with scarring

Keywords: Urinary Tract Infection, Ultrasound Kidney Ureter Bladder, Di Mercapto Succinic Acid renal scintigraphy, Micturating Cysto Urethrogram, Escherichia Coli.

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Corresponding Author

Dr K Rajendran

Professor & Head, Department of Paediatrics & Neonatology, Kovai Medical Centre, and Hospital, Coimbatore, Tamil Nadu India