Role of DMSA in pediatric UTI [letter]

I read the article published in the July 2005 issue of the Journal emphasizing the utility of DMSA (99mTc-dimercaptosuccinic acid) scans in the evaluation of acute pyelonephritis in children. It was interesting however I have some comments: 1. The authors enrolled 32 children with first episode of febrile urinary tract infections (UTI) and 10 with recurrent infection with positive urine cultures. All patients were subjected to ultrasound DMSA scan during acute phase of the infection and a voiding cystourethrogram (VCUG) was done after treatment of the episode. Vesicoureteric reflux (VUR) was present in 33 (78.6%) children and an abnormal DMSA was reported in 92.9% patients. The authors have not mentioned the grade of VUR. Also they have not mentioned the number of patients below 2 years with VUR as the incidence of structural abnormalities associated with UTI is highest in this group. All young children with febrile UTI are at increased risk of acute pyelonephritis and it is difficult to differentiate upper from lower UTI in this age group. Therefore it is recommended that all these episodes in young children be managed as pyelonephritis as they have the potential for renal scarring. The benefit of DMSA in an acute stage in this category is questionable and does not change the management of individual cases. (excerpt)