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DMSA Scan Interpretation Scarring — ESENeph MCQ

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EasyChronic Kidney DiseaseDMSA Scan Interpretation ScarringESENeph

A 45-year-old man with CKD G3b has a DMSA scan showing differential function of 60% right kidney and 40% left kidney with cortical scarring in the left lower pole. What does this indicate?

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Correct answer: A — The DMSA scan shows reduced left kidney contribution with focal cortical scarring – consistent with reflux nephropathy or chronic pyelonephritic scarring; the right kidney compensates

DMSA (dimercaptosuccinic acid) scintigraphy is the gold standard for assessing differential renal function and detecting cortical scarring. Normal split function is approximately 50:50 (±5%). This patient shows asymmetric function (60:40) with left lower pole scarring – characteristic of reflux nephropathy (VUR-related chronic pyelonephritic scarring). DMSA does not measure GFR (MAG3 or GFR studies do this). It is particularly useful for: assessing split function before considering nephrectomy, detecting cortical scarring in children with UTI/VUR, and evaluating congenital anomalies (e.g. ectopic/horseshoe kidneys).

Reference: NICE CG54 – UTI in Children; European Nuclear Medicine Guide