Vesicoureteral Reflux and Renal Scarring in Children with Acute Pyelonephritis: the Role of Late 6-month Dimercaptosuccinic Acid Renal Scan

Aim: This article aimed to review the role of cytokines, chemokines, growth factors and cellular adhesion molecules as biomarkers for vesicoureteral reflux (VUR) and reflux nephropathy (RN). Methods: We reviewed articles from 1979 onward by searching PubMed and Scopus utilizing the combination of words: ‘VUR’ or ‘RN’ and each one of the biomarkers. Results: Genetic, inflammatory, fibrogenic, environmental and epigenetic factors responsible for renal scarring need to be better understood. TGF-β, IL-10, IL-6, IL-8 and TNF seem to exert a role in VUR particularly in RN based on the current literature. Serum levels of procalcitonin have been also associated with high-grade VUR and RN. These molecules should be more intensively evaluated as potential biomarkers for renal scarring in VUR. Conclusion: Further studies are necessary to define which molecules will really be of utility in clinical decisions and as therapeutic targets for VUR and RN.

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Study of DMSA (99mTc-dimercaptosuccinic acid) scan disorders in children 1-12 years with first acute pyelonephritis and its association with vesicoureteral reflux

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20180590 ◽

2018 ◽

Vol 6 (3) ◽

pp. 751

Author(s):

Majid Vafaie ◽

Javad Zare-noghabi ◽

Hadiseh Bahri

Keyword(s):

Vesicoureteral Reflux ◽

Acute Pyelonephritis ◽

Renal Scarring ◽

High Sensitivity ◽

Cross Sectional ◽

Significant Difference ◽

Febrile Uti ◽

Dimercaptosuccinic Acid Scan ◽

Dmsa Scan ◽

Negative Urine Culture

Background: Acute pyelonephritis and vesicoureteral reflux are one of the main causes of renal scarring in children, which can lead to serious complications such as hypertension and chronic renal failure. The aim of this study was to evaluate the scan disorders in children aged 1-12 years with acute pyelonephritis and its relation with ureteral bladder reflux.Methods: This retrospective cross-sectional descriptive study was conducted on all patients who had been diagnosed with febrile UTI for 4 years (2012-2015) in Ardebil's Children's Hospital. Information about 99mTc-DMSA scan and ultrasonography and cystoyurethrography of patients were extracted from the files and then analyzed by statistical methods inSPSS.19.Results: 148 children (9 boys and 139 girls) with a range of 1 to 12 years old (mean age of 52.34±4.34 months) were included in the study. Of these, 123 patients were subjected to cystoyurethrography after a negative urine culture. A 99mTc-DMSA scan report in the acute phase of the disease was abnormal in 80.4% of the children. VCUG and RNC tests were performed in 123 patients, in 70 (57%) normal cases, and in 53 cases (43%) of urinary reflux. The incidence of reflux with abnormal 99mTc-DMSA scan was 42%. There was no significant correlation between the prevalence of reflux in patients with abnormal 99mTc-DMSA scan in two groups of 1-4 years old and more than 4 years old. No significant difference was found in patients with abnormal scan in responding to treatment and comparing fever after admission in patients with normal 99mTc-DMSA.Conclusions: The results indicate high prevalence of reflux in patients with acute pyelonephritis. Due to the high sensitivity of the scan to detect pyelonephritis and, Pyelonephritis.

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