The Relation of Vesicoureteral Reflux and Renal Scarring in Childhood Urinary Tract Infection
Suroj Supavekin MD*, Kanittha Kucivilize MD*, Saowalak Hunnangkul MSc**, Jiraporn Sriprapaporn MD***, Anirut Pattaragarn MD*, Achra Sumboonnanonda MD*
Affiliation : * Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University ** Office for Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University *** Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University
Objective : Assess the relation of age and sex in vesico ureteral reflux (VUR) and renal scarring and the relation of VUR and
renal scarring in childhood urinary tract infection.
Materials and Methods : A descriptive study of one hundred and twenty-six children who received renal cortical scintigraphy
from 1st Jan 2000 to 31st Dec 2004 in the Department of Radiology, Faculty of Medicine Siriraj Hospital, was conducted.
Ninety-three (50 males, 43 females) patients were diagnosed with urinary tract infections (UTIs) but only ninety-one of them
had renal cortical scintigraphic results available. The male to female ratio was 1.16:1. The mean age of the patients was 4.33
years (SD (cid:31) 4.17, range 7 days - 16 years). During the 1st year of life the male to female ratio is 2.6:1. Fever, dysuria, and poor
feeding were the most presenting signs and symptoms. Eighty-five (45 males, 40 females) patients received Voiding Cysto
Urethro Gram (VCUG).
Result: The authors did not find the correlation between the age groups and sex with VCUG results on right and left side,
respectively (p = 0.856, p = 0.145, p = 0.77, p = 0.75). Ninety-one (49 males, 42 females) patients received DMSA renal
scintigraphy. Fifty-two patients (57.1%) had abnormal DMSA renal scan results. However, the authors did not find the
correlation between age groups and sex with DMSA renal scan results on the right and left kidneys, respectively. (p = 0.202,
p = 0.416, p = 0.511, p = 0.791). The authors compared times of UTIs with and DMSA renal scintigraphy in each side of the
kidney. Even though the authors did find the correlation between episodes of UTIs and abnormal DMSA on the left kidneys (p
= 0.017), it was not found on the right kidneys (p = 0.081). There were 80 patients who received both VCUG and DMSA renal
scintigraphy. The authors found the correlation between severity of VUR and abnormal DMSA results on right and left
kidneys (p = 0.001, p = 0.01).
Conclusion : The authors recommend that all children who have repeated UTI and/or VUR, irrespective of age and sex,
should receive DMSA renal scintigraphy to detect renal scarring and follow up future complications.
Keywords : Urinary tract infection, Renal cortical scintigraphy, Renal scarring
