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Journal of the Korean Society of Pediatric Nephrology 2010;14(2): 195-202. doi: https://doi.org/10.3339/jkspn.2010.14.2.195
급성신우신염 환아에서 DMSA 스캔상 발견된 신결손의 예후 인자
서영선, 권덕근, 신윤혜, 배기수
1아주대학교 의과대학교 소아과학교실
2아주대학교 의과대학교 소아과학교실
3아주대학교 의과대학교 소아과학교실
4아주대학교 의과대학교 소아과학교실
Prognostic Factors of Renal Defects on the Initial DMSA Scan in Children with Acute Pyelonephritis
Yeong-Seon Seon, Duck-Geun Kwon, Yun-Hyea Shin, Ki-Soo Pai
1Department of Pediatrics, Ajou University School of Medicine
2Department of Pediatrics, Ajou University School of Medicine
3Department of Pediatrics, Ajou University School of Medicine
4Department of Pediatrics, Ajou University School of Medicine
Received: September 20, 2010;  Revised: October 11, 2010.  Accepted: October 19, 2010.
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ABSTRACT
Purpose : The purpose of this study is to determine if there are prognostic factors leading to permanent parenchymal damages to kidney in children after acute pyelonephritis.
Methods : This study was conducted in 160 pediatric patients with acute pyelonephritis admitted to Ajou University Hospital from 2000 to 2005, whose renal cortical defects were confirmed by $^{99m}Tc$-dimercaptosuccinic acid scintigraphy (DMSA scan). Along with the follow-up DMSA scan after 6 months, they were classified into two groups; recovered group (106) and scarred group (54). The clinical characteristics of each group were compared.
Results : Among the total of 160 patients, 106 (66.3%) showed recovery of the initial defect (the recovered group), while 54 (33.8%) showed permanent defects on the followup DMSA scan (scarred group). Recovery rate was poor for patients of 1 year and older, or patients with the duration of fever and pyuria longer than 7 days. The recovery rate was poor in the patients with history of frequent febrile episodes and abnormal results of imaging studies, such as voiding cystourethrography (VCUG), ultrasonography.
Conclusion : The recovery rate of children with renal defects on DMSA scan with acute pyelonephritis was lower when the patient is older than 1 year, when the duration of fever and pyuria exceeded 7 days, and when the patients had the histories of frequent febrile episodes and had urinary tract abnormalities on imaging studies. These findings suggest that there may be under- or mis-diagnosis of acute pyelonephritis by pediatrician.
Key words: Acute pyelonephritis | Urinary tract infection | $^{99m}Tc$-DMSA scintigraphy | Recovery of renal defect | Frequent febrile episode
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