ABSTRACTS PRESENTADOS AL 11th INTERNATIONAL SYMPOSIUM "RADIONUCLIDES IN NEPHRO-UROLOGY", REALIZADO EN MONTEREY, CALIFORNIA, 13-17 MAYO 2001.
25. UNRAVELLING THE ROLE OF VESICOURETIC REFLUX (VUR) AND RENAL PARENCHYMAL DAMAGE IN CHILDREN WITH URINARY TRACT INFECTION (UTI)
Gordon
I, Barkovics M and Woolf AS.
Radiology Department and Nephro-Urology
Unit. Great Ormond Street Hospital NHS Trust and Institute of Child
Health, London, UK
UTI
and subsequent renal scarring is an important cause of hypertension
and chronic renal failure in all age groups. Clinical dogma has it
that UTI and renal scarring must be linked by VUR but does a systematic
review of the literature support this contention.
We found 761 titles by searching the literature in all languages for titles, key words or abstracts which included the words UTI. micturating cystogram (MCU) VUR, dimercaptosuccinic acid (DMSA), renal damage and pyelonephritis. However, only 23 articles presented data in which all children had documented UTI and had undergone both MCU and DMSA scan. We analyzed both. "Early Kidney Involvement" (DMSA < 6 weeks post UTI) and "Renal Scarring" (DMSA >6 months post UTI). Age range in this representative paediatric population was between infancy to 18 years.
In this paediatric UTI population only half of kidneys with DMSA defects
are attached to refluxing ureters. Hence it is illogical to use MCU
as an efficient screening test to determine the need for DMSA a definitive
test for renal damage. The pathogenesis of renal damage in infection
may not required VUR for development of renal damage. VUR is however
associated with an increased incidence of renal damage and it therefore
seems prudent to look for VUR in the presence of a damaged kidney.
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