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THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING

Rivista di Medicina Nucleare e Imaging Molecolare


A Journal on Nuclear Medicine and Molecular Imaging
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ORIGINAL ARTICLES  PEDIATRICS II


The Quarterly Journal of Nuclear Medicine 1998 Giugno;42(2):119-25

lingua: Inglese

Assessment of infec­tive uri­nary ­tract dis­or­ders

Sixt R., Stokland E.

From the Departments of Pediatric Clinical Physiology and of Pediatric Radiology, Sahlgrenska University Hospital/Östra, Göteborg, Sweden


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Urinary ­tract infec­tion (UTI) is com­mon in chil­dren, par­tic­u­lar­ly in the young­est age ­groups. There is a ­risk for pro­gres­sive dete­ri­ora­tion of ­renal func­tion in ­these chil­dren if aggra­vat­ing fac­tors ­such as ­gross ­reflux and/or out­flow obstruc­tion of the uri­nary ­tract are ­present. In ­this ­review the ­pros and ­cons of avail­able scin­ti­graph­ic and radio­log­i­cal imag­ing tech­niques for the ­work-up of ­these chil­dren are pre­sent­ed. Ultrasound can be ­used in the ­acute ­phase to ­exclude obstruc­tion but can not reli­ably ­show tran­sient or per­ma­nent paren­chy­mal ­lesions. The pres­ence of ­reflux can be estab­lished ­with X-ray or ­direct ­nuclide cys­tog­ra­phy. The X-ray tech­nique ­gives ­good mor­pho­log­i­cal infor­ma­tion and has a grad­ing ­system ­with prog­nos­tic rel­e­vance. Both tech­niques are inva­sive and ­great ­care ­must be tak­en to ­keep the radi­a­tion bur­den ­down ­with the X-ray tech­nique. Indirect ­nuclide cys­tog­ra­phy fol­low­ing a ren­o­graph­ic ­study is non-inva­sive but has a low­er sen­si­tiv­ity ­than ­direct tech­niques. More expe­ri­ence is need­ed ­with the indi­rect tech­nique to eval­u­ate the con­se­quenc­es of its appar­ent­ly low sen­si­tiv­ity. Urography has a limited ­place in the ­acute ­work-up of uri­nary ­tract infec­tion but can be ­used to ­look for ­renal scar­ring 1-2 ­years ­after an ­acute pye­lo­neph­ritis. The 99mTc dimer­cap­tos­uc­cin­ic ­acid (­DMSA) ­scan can be ­used dur­ing the ­acute UTI to ­show pye­lon­eph­rit­ic ­lesions ­with ­good accur­a­cy and/or dur­ing the fol­low-up ­after six ­months to ­show per­ma­nent ­lesions. The ­acute ­DMSA ­scan can be omit­ted. An ear­ly treat­ment is ­more impor­tant ­than an ear­ly ­scan!

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