Buket KILIÇASLAN, Handan ALP, Mustafa YILDIRIM, Tacettin İNANDI

Çocuklarda akut piyelonefrit ve böbrek parankim zedelenmesinde MAG3 sintigrafinin ve DMSA sintigrafinin tanısal değeri

Amaç: Çalışmamızda, bulgu veren ilk idrar yolu enfeksiyonu olan çocuklarda akut piyelonefrit ve böbrek parankim zedelenmesinde MAG3 sintigrafinin tanısal değeri ve DMSA sintigrafi ile karşılaştırılması amaçlanmıştır. Gereç ve Yöntem: İdrar yolu enfeksiyonu düşündüren şikayetlerle başvuran, daha önce idrar yolu enfeksiyonu tanısı almamış, 70 hasta çalışma kapsamına alındı. Çalışmaya alınan tüm hastaların tedavisi yapılmadan önce, kan ve idrar örnekleri alınarak, lökosit sayısı, sedimentasyon hızı, C-reaktif protein konsantrasyonu saptandı. Böbrek parankim zedelenmesinin saptanmasında DMSA sintigrafi 'altın standart' tanı yöntemi kabul edildi. Bulgu veren ilk idrar yolu enfeksiyonu tanısı alan çocuklarda, böbrekte parankim zedelenmesini saptamada MAG3 sintigrafinin duyarlılık, seçicilik, pozitif ve negatif kestirim değeri saptandı. Bulgular: Çalışmamızın sonucunda, piyelonefrit ve sistitli olgularımızın ayrımında ateş, lökosit, C-reaktif protein ve sedimentasyon yüksekliği istatistiksel olarak oldukça anlamlı bulundu; ancak, bu değerlerin, DMSA sintigrafide saptanan parankim zedelenmesinin şiddetini göstermede istatistiksel olarak anlamlılık taşımadığı saptandı. Böbrek parankim zedelenmesini göstermede, MAG3 sintigrafinin duyarlılığı % 32,5, seçiciliği ise % 98,1 saptandı. Sonuç: Çocuklarda, MAG3 sintigrafinin böbrek parankim zedelenmesini belirlemede DMSA sintigrafinin yerini alamayacağı kanısına varıldı.

Anahtar Kelimeler:

Piyelonefrit, MAG3, DMSA, sintigraf

Diagnostic value of MAG3 scintigraphy and DMSA scintigraphy in renal parenchyma damage and acute pyelonephritis of children

Purpose: In this study, we aimed to compare diagnostic value of MAG3 scintigraphy in renal parenchyma damage and acute pyelonephritis, in the first urinary tract infection in children, with DMSA scintigraphy. Material and Methods: Seventy patients who never diagnosed before but admitted with complaints of urinary tract infection for the first time, were included in this study. Before the treatment of all patients in the study were taken blood and urine samples, and leukocyte count, erythrocyte sedimentation rate, C-reactive protein concentration were determined. DMSA scintigraphy in detection of renal parenchyma damage was accepted as "gold standard". In the detection of damage in renal parenchyma, positive and negative predictive value, selectivity and sensitivity of MAG3 scintigraphy were detected.Results: The fever, elevated leukocytes, C-reactive protein and sedimentation rate were found statistically significant in the detection of pyelonephritis. However, these values were not significant statistically in the demonstration of the severity of parenchyma damage. In the detection of damage in renal parenchyma, MAG3 scintigraphy had a sensitivity of 32.5 % and a specificity of 98.1 %. Conclusion: MAG3 scintigraphy can not replace DMSA scan to determine the renal parenchyma damage in childhood.

Keywords:

Pyelonephritis, MAG3, DMSA,

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