The Diagnostic Value of Clinical and Radiologic Findings in Children after the First Episode of Acute Pyelonephritis

Kim, Ji Hae; Kim, Mi Jung; Choi, Byung Min; Yoo, Kee Hwan; Hong, Young Sook; Lee, Joo Won

J Korean Soc Pediatr Nephrol > Volume 9(2); 2005 > Article

J Korean Soc Pediatr Nephrol 2005;9(2): 201-212.

소아에서의 첫 번째 급성 신우신염에 따른 임상 소견 및 방사선학적 검사의 진단적 유용성

김지혜, 김미정, 최병민, 유기환, 홍영숙, 이주원

¹고려대학교 의과대학 소아과학교실
²고려대학교 의과대학 소아과학교실
³고려대학교 의과대학 소아과학교실
⁴고려대학교 의과대학 소아과학교실
⁵고려대학교 의과대학 소아과학교실
⁶고려대학교 의과대학 소아과학교실

The Diagnostic Value of Clinical and Radiologic Findings in Children after the First Episode of Acute Pyelonephritis

Ji Hae Kim, Mi Jung Kim, Byung Min Choi, Kee Hwan Yoo, Young Sook Hong, Joo Won Lee

¹Department of Pediatrics, College of Medicine, Korea University
²Department of Pediatrics, College of Medicine, Korea University
³Department of Pediatrics, College of Medicine, Korea University
⁴Department of Pediatrics, College of Medicine, Korea University
⁵Department of Pediatrics, College of Medicine, Korea University
⁶Department of Pediatrics, College of Medicine, Korea University

ABSTRACT

Purpose : Acute pyelonephritis is one of the most common causes of unexplained fever in children. It may lead to the development of progressive renal damage. However, the deteclion of acute pyelonephritis can be difficult, especially in infants. The objective of this study was to evaluate the diagnostic value of various lab tests and imaging studies for acute renal parenchymal changes in children with APN. We correlated the clinical and laboratory manifestations of acute pyelonephritis with the Imaging studies.
Methods : We reviewed the records of 115 children (85 males and 30 females) who were hospitalized Outing the period of January 1998 to December 2002 with initial clinical symptoms suggestive of pyelonephritis. The patients' age, sex, duration of fever, laboratory findings, and causative organisms were compared with the findings of imaging studies (Technetium-99m dimercaptosuccinic acid renal scan, renal ultrasonography, intravenous pyelography, voiding cystourethrography).
Results : No significant relation between the number of febrile days, leukocyte count, causative organism, and the renal abnormalities in the imaging studies were observed. On the other hand, both C-reactive protein and erythrocyte sedimentation rate levels were significantly elevated in children with positive dimercaptosuccinic acid renal scan. Furthermore, females and children older than 1 year presented with significantly higher rate of abnormal dimercaptosuccinic acid renal scan findings and vesicoureteral reflux presented by voiding cystourethrography.
Conclusion : We recommend females and children older than 1 year who are suspected of acute pyelonephritis be evaluated carefully for renal involvement by performing imaging studies including dimercaptosuccinic acid renal scan and voiding cystourethrography. (J Koroan Soc Pediatr Nephrol 2005;9:201-212)