Are Sequential DMSA Scans Necessary in Children?
OBJECTIVES: We investigate DMSA scans for the monitoring of children with spina bifida, renal scarring, VUR and UTI, and also in older children.
METHODS: Serial paediatric DMSA scans performed between July 2000 and August 2007 were reviewed by a single reader and graded according to a modified Goldraich’s system.
RESULTS: 98 patients (183 kidneys), age range 6 weeks -17 years, underwent 213 studies. 1 patient was excluded as they had fused crossed ectopia. 13 patients underwent 3 studies, 1 underwent 4 studies and 1 patient had 6 studies. 75 patients had no change (164 studies, 140 kidneys), 5 improved (11 studies, 7/10 kidneys), and 16 had worsening of renal scarring (34 studies, 18/31 kidneys). 2 patients had post nephrectomy follow-up scans. Of patients with worsening renal scarring, 7/16 had spina bifida, 1/16 had obstruction, and 8/16 documented VUR.
Of the 9 patients without spina bifida, 7 kidneys in 7 patients developed significant renal scarring altered their medical management: 5 kidneys - Goldraich grade 3 to 4 and 2 kidneys - Goldraich grade 1 to 3 (1 had grade 4 VUR and the other had VUJ obstruction). Only 1 initially unscarred kidney developed scarring between studies (Goldraich grade 0 to 1). No new renal scarring developed after the age of 5 years.
CONCLUSIONS: Sequential DMSA scans may show progressive abnormalities in paediatric patients with spina bifida, and in previously scarred kidneys with high grade VUR. No scarring developed in initially normal kidneys after age 5 years.