Extent of renal damage in children with vesico-ureteral reflux grade III according to 99mTc-DMSA scan grading

Czech version

Authors: Chroustová Daniela ¹; Černá Linda ¹; Trnka Jiří ¹; Langer Jan ²; Urbanová Ivana ³; Kočvara Radim ⁴
Authors‘ workplace: Ústav nukleární medicíny, 1. lékařská fakulta, Univerzita, Karlova, Všeobecná fakultní, nemocnice, Praha ¹; Klinika pediatrie a klinických, poruch metabolismu, 1. lékařská fakulta, Univerzita, Karlova, Všeobecná fakultní, nemocnice, Praha ²; Dětské oddělení, FN Bulovka, Praha ³; Urologická klinika, 1. lékařská, fakulta, Univerzita Karlova, Všeobecná fakultní nemocnice, Praha ⁴
Published in: Čes-slov Pediat 2024; 79 (6): 335-340.
Category: Original Papers
doi: https://doi.org/10.55095/CSPediatrie2024/059

Overview

Introduction: The aim of this study was to determine the risk of renal damage in children diagnosed with vesico-ureteral reflux (VUR) grade III, which is generally considered as a low-grade VUR, according to the occurrence of renal changes using the ^99mTc-DMSA scan grading.

Methods: A total of 132 patients with VUR were examined (56 boys, 76 girls aged 6 months -11 years) 6 months after acute pyelonephritis with. Static renal scintigraphy was performed 2 h after i.v. administration of 18-80 MBq ^99mTc-DMSA. Determination of the degree of kidney involvement according to the ^99mTc-DMSA grading G0-G4 (Mattoo et al) was based on the number of affected segments (0-12). The number of pathological segments/scars was assessed in each involved kidney. Mean values within each VUR grade were evaluated using Student’s t-test.

Results: 200 kidneys were evaluated. VUR III. grade demonstrated significantly higher value of scars (2.88 vs 1.58, p = 0.002) than the remaining low-risk grades I and II.

On the other hand, when compared with high-risk grade IV, the value was not significantly lower (2,88 vs. 3,51, p = 0,08).

In comparing VUR III. with VUR IV.-V. grades, there was a significantly higher number of scars in high-grade VUR. (3.99 vs. 2.88, p = 0.004).

Conclusion: VUR III. grade is associated with a higher extend of parenchymal changes (according to ^99mTc-DMSA grading) compared to low grades VUR I. and II. ^99mTc-DMSA grading can unmask more severe cases of VUR III. degree, which we therefore recommend separating and evaluating as a separate degree.

Keywords:

99mTc-DMSA scintigraphy – vesico-ureteral reflux – renal parenchymatous changes – childhood age

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