Pediatric Urinary Tract Infections and Kidney Monitoring

Urinary tract infection (UTI)

Hello, doctor.
My daughter has had three urinary tract infections within three months, and imaging has revealed bilateral grade III vesicoureteral reflux.
The nephrologist has scheduled a DMSA scan to check for kidney scarring.
I would like to ask: 1) Is the radiation dose for this test high? 2) Are there any side effects? 3) Besides DMSA, what other methods can be used to monitor for kidney damage or scarring? Thank you, doctor.

Mama, 30~39 year old female. Ask Date: 2021/10/06

Dr. Pei Rensheng reply Pediatrics

Hello! My daughter has had three urinary tract infections in the past three months, and imaging has revealed bilateral grade III vesicoureteral reflux.
The nephrologist has ordered a DMSA scan to monitor for kidney scarring.

1) Is the radiation dose from this test high?
Answer: The radiation dose from a chest X-ray is 0.014 mSv; the dose for DMSA (in adults) is 0.7 mSv, and for children, the dose is weight-dependent and will be lower than 0.7 mSv, but still significantly higher than a chest X-ray.
On average, each person in Taiwan receives 1.6 mSv per year, so there is no need for concern!
2) Are there any side effects?
Answer: After the injection, the patient retains a very small amount of radiation, which is so low that no special precautions are necessary.
However, it is recommended that the patient avoid close contact with pregnant women and children under six years old for one day after the test.
Drinking plenty of water and urinating frequently after the exam can help expedite the elimination of the radioactive material.
According to both domestic and international literature and clinical experience, the radiation dose from this test is unlikely to increase cancer risk or the risk of infertility or congenital anomalies in offspring.
3) Are there any other methods besides DMSA to monitor for kidney damage or scarring?
Answer: Currently, there is no better alternative to DMSA for this purpose.
Wishing you health and safety! Sincerely, Ren Sheng.

Reply Date: 2021/10/06

More Info

Understanding pediatric urinary tract infections (UTIs) and the monitoring of kidney health is crucial, especially in young children who may be more susceptible to complications. Your concerns regarding the DMSA (Dimercaptosuccinic acid) scan, which is often used to assess kidney function and detect scarring, are valid and important for ensuring the best care for your daughter.

1. Radiation Dose of DMSA Scan: The DMSA scan does involve exposure to radiation, but the levels are relatively low. For adults, the typical radiation dose is about 0.7 mSv, while for children, the dose is adjusted based on their weight and is generally lower than that for adults. To put this into perspective, a chest X-ray typically delivers a dose of about 0.014 mSv. The average person in the U.S. is exposed to about 1.6 mSv of natural background radiation per year. Therefore, while there is some exposure, it is not considered excessively high, especially when weighed against the benefits of accurately assessing kidney health.

2. Potential Side Effects: The DMSA scan is generally safe, and serious side effects are rare. The radiation exposure is minimal, and the amount of radioactive material used is very small. After the scan, it is advisable for the patient to drink plenty of fluids to help flush the radioactive material from their system. The only precaution is to avoid close contact with pregnant women and children under six for a short period after the scan, as a general safety measure. There is no significant increase in cancer risk or reproductive issues associated with the radiation dose from a DMSA scan.

3. Alternative Methods for Monitoring Kidney Damage: Currently, DMSA remains one of the most reliable methods for assessing kidney scarring and function. However, there are other imaging techniques that can provide valuable information about kidney health. Ultrasound is a non-invasive method that can be used to visualize the kidneys and urinary tract, helping to identify structural abnormalities or obstructions. While it does not provide information about scarring, it can be useful in the initial assessment of kidney health. Additionally, MRI (Magnetic Resonance Imaging) can be used in some cases, but it is less common due to cost and availability, and it may not be suitable for all patients, especially very young children.

In summary, while the DMSA scan does involve some radiation exposure, it is considered safe and is a valuable tool for monitoring kidney health in children, especially those with a history of urinary tract infections and potential kidney damage. It is essential to weigh the risks and benefits of any medical procedure, and in this case, the potential for early detection and management of kidney issues can significantly outweigh the minimal risks involved. Regular follow-ups with a pediatric nephrologist can help ensure that your daughter receives the best possible care and monitoring for her condition.

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