Rôle de la scintigraphie au DMSA dans la prise en charge des pyélonéphrites de l'enfant

Pyelonephritis in children may lead to irreversible renal damage and eventually to arterial hypertension and renal insufficiency. Inflammation plays a central role in the pathogenesis of pyelonephritis. Dimercaptosuccinic acid (DMSA) scintigraphy permits detection of acute renal lesions and renal scars with high sensitivity and specificity. In our experience 60% of patients who had acute renal lesions on DMSA scintigraphy during pyelonephritis develop scars. Young age appears to be not a risk factor, as in our experience 70% of children older than 5 years develop scars compared to 40% for children younger than 1 year. In addition, only 40% of patients who develop scars have vesicoureteral reflux. DMSA scintigraphy may provide answers to important clinical questions: what is the optimal length of treatment of pyelonephritis? Is parenteral treatment necessary? What is the best treatment of vesicoureteral reflux? DMSA scintigraphy permits therapeutical decision-making according to the renal involvement in each of our patients

Procalcitonin is a marker of severity of renal lesions in pyelonephritis

In an attempt to differentiate acute pyelonephritis from lower urinary tract infection (UTI), we measured serum procalcitonin levels, a recently described marker of infection. We compared it with other commonly used inflammatory markers and evaluated its ability to predict renal involvement as assessed by dimercaptosuccinic acid (DMSA) scintigraphy