DMSA AND VESICOURETERIC REFLUX DIAGNOSIS AND SIGNIFICANCE IN UTI IN CHILDREN FROM BARUCH PADEH PORIYA MEDICAL CENTER-ISRAEL.

Background and Objective: Definitive diagnosis of vesicoureteral reflux (VUR) is by voiding cystourethrogram (VUCG), yet this is an uncomfortable procedure and does not detect renal scars. Technetium 99m Tc dimercaptosuccinic acid (DMSA) scintigraphy is currently the standard test for detecting renal scars. The aim of the current study was to examine the capability of urinary system ultrasonography (USG) and DSMA to distinguish VUR, and thus to replace VUCG. Methods: Analysis of medical records of children, from birth to age 9 years, with symptoms of urinary tract infection who underwent VUCG for detection of VUR at one medical center. Results: Of 88 children, 73 (83%) were girls, 72 (97%) had fever. VCUG detected VUR in 33 (38%). USG revealed abnormal findings in 44% (14/32) of the children with VUR and 41% (22/54) of those without VUR. Of the 36 children with abnormal findings on DSMA, 33% were without VUR and 24 (67%) with VUR: 8/24 (33%) had VUR grade 1-2 and 16/24 (67%) VUR grade 3-5. Of the 33 with normal DSMA findings 27 (82%) were without VUR and 6 (18%) with VUR: 4/6 (67%) had VUR grade 1-2 and 2 (33%) VUR grade 3-5. Conclusions: USG findings were not shown to distinguish VUR or to be associated with DMSA findings. DMSA does not appear as a means of replacing VCUG for the detection of VUR, since an abnormal DMSA occurred in almost one-third of children with UTI and without VUR. Abbreviations UTI: urinary tract infection; VUR: vesicoureteral reflux; VCUG: voiding cystourethrogram; DMSA: dimercaptosuccinic acid; USG: ultrasonography