Evaluation of Dimercaptosuccinic Acid Scan (DMSA) findings and it’s correlation with clinical and paraclinical parameters in children with pyelonephritis

Mahmoudzadeh, Hashem; Valizadeh, Mohammad; Hajilou, Zahra

doi:10.61186/JBUMS.32.1.27

Volume 32, Issue 1 (Spring 2025) J Birjand Univ Med Sci. 2025, 32(1): 27-36 | Back to browse issues page

‎ 10.61186/JBUMS.32.1.27

Research code: N/A

Ethics code: IR.UMSU.REC.1401.274

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Mahmoudzadeh H, Valizadeh M, Hajilou Z. Evaluation of Dimercaptosuccinic Acid Scan (DMSA) findings and it’s correlation with clinical and paraclinical parameters in children with pyelonephritis. J Birjand Univ Med Sci. 2025; 32 (1) :27-36
URL: http://journal.bums.ac.ir/article-1-3503-en.html

Evaluation of Dimercaptosuccinic Acid Scan (DMSA) findings and it’s correlation with clinical and paraclinical parameters in children with pyelonephritis

Hashem Mahmoudzadeh¹

, Mohammad Valizadeh ^*²

, Zahra Hajilou¹

1- Department of Pediatrics, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
2- Nephrology and Kidney Transplant Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran , mohammad_k_v@yahoo.com

Keywords: Children, DMSA scan, Paraclinical findings, Pyelonephritis

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Background and Aims: Urinary tract infections (UTIs) are among the most common infections in children and can lead to permanent renal damage. Technetium-99m-DMSA scanning is considered the gold standard for diagnosing pyelonephritis. This study aimed to assess DMSA scan findings and evaluate their correlation with clinical and paraclinical parameters in children with pyelonephritis.
Materials and Methods: In this descriptive-analytical study, 109 children aged 6 months to 12 years, hospitalized with pyelonephritis at Shahid Motahari Hospital in Urmia, Iran, from September 2023 to May 2024, were enrolled. Demographic data, clinical symptoms, laboratory results—including white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)—and DMSA scan findings were collected. Statistical analysis was performed using SPSS version 27.0 and the Chi-square test. A p-value <0.05 was considered statistically significant.
Results: The mean age of patients was 5.82±2.34 years, and 76.15% were female. Fever, anorexia, pain, irritability, and vomiting were the most frequent symptoms. DMSA scans showed bilateral renal involvement in 57 (52.30%) cases. Leukocytosis was found in 31 (28.44%) cases, positive CRP in in 69 (63.30%) cases, and elevated ESR in in 73 (66.97%) patients. While ESR and CRP were not significantly associated with renal damage severity, leukocytosis and high-grade fever (>38°C) had significant correlations with severe renal involvement.

Conclusion: The results of this study showed that clinical indicators such as high-grade fever may serve as early warning signs of renal damage in children with pyelonephritis. Nevertheless, DMSA scanning remains indispensable for the definitive detection of renal parenchymal injury.

Type of Study: Original Article | Subject: Nephrology
Received: 2025/02/23 | Accepted: 2025/05/11 | ePublished ahead of print: 2025/06/10 | ePublished: 2025/04/4

References

1. Mattoo TK, Shaikh N, Nelson CP. Contemporary management of urinary tract infection in children. Pediatrics. 2021; 147(2): e2020012138. DOI: 10.1542/peds.2020-012138 [DOI:10.1542/peds.2020-012138] [PMID]

2. Morello W, La Scola C, Alberici I, Montini G. Acute pyelonephritis in children. Pediatr Nephrol. 2016; 31: 1253-65. DOI: 10.1007/s00467-015-3168-5 [DOI:10.1007/s00467-015-3168-5] [PMID]

3. Montini G, Spencer JD, Hewitt IK. Urinary tract infections in children. In Pediatric Nephrology 2022 Sep 2. Cham: Springer International Publishing. 8 ed. pp: 1323-1342. DOI: 10.1007/978-3-030-52719-8_49 [DOI:10.1007/978-3-030-52719-8_49]

4. Okarska-Napierała M, Wasilewska A, Kuchar E. Urinary tract infection in children: Diagnosis, treatment, imaging-Comparison of current guidelines. J Pediatr Urol . 2017; 13(6): 567-73. DOI: 10.1016/j.jpurol.2017.07.018 [DOI:10.1016/j.jpurol.2017.07.018] [PMID]

5. Tahlili R, Mardanshahi A, Abedi SM, Mohammadjafari H. The Role of Quantitative DMSA Scan Analysis in Assessing Prognosis of Acute Pyelonephritis in Children. Clin Pediatr. 2024; 64(7): 00099228241307441. DOI: 10.1177/00099228241307441 [DOI:10.1177/00099228241307441] [PMID]

6. Han JH, Rhie S, Lee JH. Predictors of renal scars in infants with recurrent febrile urinary tract infection: a retrospective, single-center study. Child Kidney Dis. 2022; 26(1): 52-7. DOI: 10.3339/ckd.22.019 [DOI:10.3339/ckd.22.019]

7. Leroy S, Fernandez-Lopez A, Nikfar R, Romanello C, Bouissou F, Gervaix A, et al. Association of procalcitonin with acute pyelonephritis and renal scars in pediatric UTI. Pediatrics. 2013; 131(5): 870-9. DOI: /10.1542/peds.2012-2408 [DOI:10.1542/peds.2012-2408] [PMID]

8. Bressan S, Andreola B, Zucchetta P, Montini G, Burei M, Perilongo G, et al. Procalcitonin as a predictor of renal scarring in infants and young children. Pediatr Nephrol. 2009; 24(6): 1199-204. DOI: 10.1007/s00467-009-1125-x [DOI:10.1007/s00467-009-1125-x] [PMID]

9. Shaikh KJ, Osio VA, Leeflang MM, Shaikh N. Procalcitonin, C‐reactive protein, and erythrocyte sedimentation rate for the diagnosis of acute pyelonephritis in children. Cochrane Database Syst Rev. 2020; 9(9): :CD009185. DOI: 10.1002/14651858.CD009185.pub3 [DOI:10.1002/14651858.CD009185.pub3] [PMID] []

10. Lee J, Woo BW, Kim HS. Prognostic factors of renal scarring on follow-up DMSA scan in children with acute pyelonephritis. Child Kidney Dis. 2016; 20(2): 74-8. DOI: 10.3339/jkspn.2016.20.2.74 [DOI:10.3339/jkspn.2016.20.2.74]

11. Shaikh N, Ewing AL, Bhatnagar S, Hoberman A. Risk of renal scarring in children with a first urinary tract infection: a systematic review. Pediatrics. 2010; 126(6): 1084-91. DOI: 10.1542/peds.2010-0685 [DOI:10.1542/peds.2010-0685] [PMID]

12. Horsager TH, Hagstrøm S, Skals R, Winding L. Renal scars in children with febrile urinary tract infection-Looking for associated factors. J Pediatr Urol. 2022; 18(5): 682. e1-. e9. DOI: 10.1016/j.jpurol.2022.09.012 [DOI:10.1016/j.jpurol.2022.09.012] [PMID]

13. Nickavar A, Safaeian B. Radiologic and clinical evaluation of children with first febrile urinary tract infection. International J Pediatr Adolesc Med. 2015; 2(1): 24-8. DOI: 10.1016/j.ijpam.2015.03.005 [DOI:10.1016/j.ijpam.2015.03.005] [PMID] []

14. Pietropaolo G, Di Sessa A, Tirelli P, Miraglia del Giudice E, Guarino S, Marzuillo P. Kidney involvement during the course of febrile urinary tract infection. Pediatr Nephrol. 2025: 1-14. DOI: 10.1007/s00467-025-06695-4 [DOI:10.1007/s00467-025-06695-4] [PMID]

15. Colceriu M-C, Aldea PL, Boț A-L, Bulată B, Delean D, Grama A, et al. The Utility of Noninvasive Urinary Biomarkers for the Evaluation of Vesicoureteral Reflux in Children. Int J Mol Sci. 2023; 24(24): 17579. DOI: 10.3390/ijms242417579 [DOI:10.3390/ijms242417579] [PMID] []

16. Ghasemi K, Montazeri S, Pashazadeh AM, Javadi H, Assadi M. Correlation of 99mTc-DMSA scan with radiological and laboratory examinations in childhood acute pyelonephritis: a time-series study. Int Urol Nephrol. 2013; 45(4): 925-32. DOI: 10.1007/s11255-013-0479-y [DOI:10.1007/s11255-013-0479-y] [PMID]

17. Mattoo TK, Mohammad D. Primary vesicoureteral reflux and renal scarring. Pediatr Clin North Am. 2022; 69(6): 1115-29. DOI: 10.1016/j.pcl.2022.07.007 [DOI:10.1016/j.pcl.2022.07.007] [PMID]

18. Valavi E, Ziaee Kajbaf T, Ahmadzadeh A, Nikfar R, Najafi R. Clinical correlation between findings of renal scintigraphy and clinical/laboratory findings in children with febrile UTI. Jundishapur Sci Med J. 2012; 11(1): 35-42. URL: https://jsmj.ajums.ac.ir/article_49462.html

19. Daniel M, Szymanik-Grzelak H, Sierdziński J, Podsiadły E, Kowalewska-Młot M, Pańczyk-Tomaszewska M. Epidemiology and risk factors of UTIs in children-A single-center observation. J Pers Med. 2023; 13(1): 138. DOI: 10.3390/jpm13010138 [DOI:10.3390/jpm13010138] [PMID] []

20. Fahimi D, Khedmat L, Afshin A, Jafari M, Bakouei Z, Beigi EH, et al. Demographic, clinical, and laboratory factors associated with renal parenchymal injury in Iranian children with acute pyelonephritis. BMC Infect Dis. 2021; 21: 1-8. DOI: 10.1186/s12879-021-06798-x [DOI:10.1186/s12879-021-06798-x] [PMID] []

21. Greenfield SP. The Diagnosis and Medical Management of Vesicoureteral Reflux: An Update and Current Controversies. In: Puri, P. (eds) Pediatric Surgery 2022. Springer, Berlin, Heidelberg.pp: 277-98. DOI: 10.1007/978-3-662-43567-0_178 [DOI:10.1007/978-3-662-43567-0_178]

22. Yang EM, Yoon BA, Kim SW, Kim CJ. Clinical utility of spot urine protein-to-creatinine ratio modified by estimated daily creatinine excretion in children. Pediatr Nephrol. 2017; 32: 1045-51. DOI: 10.1007/s00467-017-3587-6 [DOI:10.1007/s00467-017-3587-6] [PMID]