NDT Advance Access originally published online on April 18, 2007
Nephrology Dialysis Transplantation 2007 22(8):2213-2216; doi:10.1093/ndt/gfm155
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Accuracy of ultrasonic detection of renal scarring in different centres using DMSA as the gold standard
1Department of Paediatric Nephrology, Evelina Children's Hospital, Guys & St Thomas’ NHS Foundation Trust, London, 2Department of Paediatrics, Royal Lancaster Infirmary, Lancaster, 3Department of Radiology, Blackpool Victoria Hospital, Blackpool and 4Department of Paediatric Nephrology, Central Manchester and Royal Manchester Children's Hospitals NHS Trust, Manchester M27 4HA, UK
Correspondence and offprint requests to: Dr M. D. Sinha, Department of Paediatric Nephrology, Room 64, Sky Level, Evelina Children's Hospital, Lambeth Palace Road, Guys & St Thomas’ NHS Foundation Trust, London SE1 7EH, UK. Email: manish.sinha{at}gstt.nhs.uk
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Abstract |
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Background. There is an ongoing debate over the radiological investigations of children with urinary tract infections (UTIs) with some authorities suggesting that ultrasound scan (USS) alone is an accurate tool to diagnose renal parenchymal scarring post-pyelonephritis. All studies on this subject have been performed at paediatric teaching centres whereas most children with UTIs are managed by General Paediatricians in District General Hospitals (DGHs) in the United Kingdom. We wished to identify whether results of scans in DGHs differed from those in teaching centres.
Methods. We looked at all children with a clinical history of UTIs having a DMSA and USS over a one year period in two DGHs and one teaching centre. A total of 476 children's results were reviewed, 297 from the DGHs and 179 from the teaching centre.
Results. The cohort had a total of 949 renal units. There were 79 scarred renal units (kidneys) on DMSA (8%) in 72 patients (15%). Just 18 renal units were detected as being scarred on USS (22.8%). Nine of 32 scarred renal units in the teaching centre were detected compared with nine of 47 in the DGHs (P = 0.40). Thirty-nine (49%) of the scarred renal units were in patients >5-years old. Of these 12 (30.7%) were detected on USS, nine of 17 within the teaching centre compared with just three of 22 at the DGHs (P = 0.01).
Conclusion. Overall only a small percentage of scars are detected on USS. In the over 5-year old group, where USS alone might be preferred, DGHs were significantly worse at detecting scarred kidneys. We conclude that if the detection of renal scars is a prime reason for imaging in children with UTIs, ultrasonography alone is inappropriate at any age and DMSA ought to be the primary investigation.
Keywords: children; dimercaptosuccinic acid scan; investigation; ultrasound scan; urinary tract infection
Received for publication: 28.12.06
Accepted in revised form: 28. 2.07