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The first and ultimate scintigraphy findings in children after acute UTI with P-fimbriated E.coli

Objective: The urinary tract infections (UTI) are very frequent in children. In the worst case they can lead to renal failure because of renal scarring. The most sensitive test for detecting renal parenchyma involvement in UTI is DMSA renal scintigraphy. In this study we compared DMSA scintigraphy done after first UTI with P fimbriated E.coli with control scintigraphy to discern ultimate parenchymal damage. Methods: Twenty-three children (46 kidneys) with first UTI with P fimbriated E.coli were enrolled in the study. Children were aged between few months and 10 years. All children were treated with adequate antibiotic therapy. DMSA scintigraphy was performed in a few days after infection and control scintigraphy was performed 5 months to 36 months later. DMSA findings were categorised as normal, generally diminished uptake of activity, focally diminished uptake of activity and clearly pathologic with renal scars. Results: The first DMSA scintigraphy immediately after infection was normal in 12 kidneys (26.1%), generally diminished activity was found in 21 kidneys (45.7%) and focally diminished activity in 6 kidneys (13% ). Renal scars were present in 7 kidneys (15.2%). On the control scintigraphy 20 kidneys (43.5%) had normal findings. Generally diminished activity were found in 6 kidneys (13%) and focal diminished uptake in 8 kidneys (17.4%). Significantly higher number of scars, in 12 kidneys (26.1%), despite of antibiotic treatment were found on the control scintigraphy (p< 0.01). Conclusion: DMSA scintigraphy demonstrated that the infection with P-fimbriated E.coli can result in permanent renal damage, which clearly points to UTI with P-fimbriatedE.coli as a risk factor in renal damage. Our results confirm obligatory scintigraphic follow-up of children with positive P-fimbriatedE.coli infection.

ultimate scintigraphy P-fimbriated E.-coli; children

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