The Role of Left Renal Vein Entrapment Phenomenon in Children with Asymptomatic Non-glomerular Hematuria / 대한신장학회잡지

PURPOSE: Left renal vein entrapment syndrome has been suggested as an etiology for asymptomatic non-glomerular hematuria since it was reported as a cause of unilateral gross hematuria. Reported diagnostic criteria has been controversial since various degrees of left renal vein entrapment was found in normal children. Some of asymptomatic non-glomerular hematuria was not diagnosed even with renal biopsies but was usually known to have self-limited benign course. We analyzed the relationship between asymptomatic non-glomerular hematuria of unknown origin and the degree of left renal vein entrapment phenomenon. METHODS: The renal doppler sonograpy of 92 children with asymptomatic non-glomerular hematuria [gross hematuria(GH) N=44, microscopic hematuria (MH) N=48] were compared to 30 control children with normal renal function and urinalysis who underwent renal doppler sonography for abdominal pain and enuresis from January, 1999 to Febrary, 2000 at Ewha Womans Mokdong Hospital. The narrowed diameter(ND) of the left renal vein between the aorta and superior mesenteric artery and its maximal velocity(NV), and the dilated diameter(DD) of the left renal vein and its maximal velocity(DV) were measured and the DD/ND and NV/DV ratio were compared with those of the control children and the results of several previous reports. RESULTS: The DD/ND ratio was 3.9+/-1.89 in the GH group, 2.4+/-0.62 in the MH group, and 2.0+/-0.48 in the control group. There was a significant difference among GH, MH and control group(p<0.05). The NV/DV ratio was 3.6+/-2.37 in the GH group was significantly higher than 1.9+/-0.60 in the MH group and 1.7+/-0.55 in the control group(p<0.05). There was no significant differences between MH and control groups. Normal cut off values of DD/ND and NV/DV ratio in this study were 3.0 and 2.8 which was different to previous reports. CONCLUSION: Left renal vein entrapment phenomenon should be considered as one of the etiology of asymptomatic non-glomerular hematuria in children and the sonographic diagnostic criteria for Left renal vein entrapment syndrome needs to be revised.

The Role of Left Renal Vein Entrapment Phenomenon in Children with Asymptomatic Non-glomerular Hematuria / 대한신장학회잡지

PURPOSE: Left renal vein entrapment syndrome has been suggested as an etiology for asymptomatic non-glomerular hematuria since it was reported as a cause of unilateral gross hematuria. Reported diagnostic criteria has been controversial since various degrees of left renal vein entrapment was found in normal children. Some of asymptomatic non-glomerular hematuria was not diagnosed even with renal biopsies but was usually known to have self-limited benign course. We analyzed the relationship between asymptomatic non-glomerular hematuria of unknown origin and the degree of left renal vein entrapment phenomenon. METHODS: The renal doppler sonograpy of 92 children with asymptomatic non-glomerular hematuria [gross hematuria(GH) N=44, microscopic hematuria (MH) N=48] were compared to 30 control children with normal renal function and urinalysis who underwent renal doppler sonography for abdominal pain and enuresis from January, 1999 to Febrary, 2000 at Ewha Womans Mokdong Hospital. The narrowed diameter(ND) of the left renal vein between the aorta and superior mesenteric artery and its maximal velocity(NV), and the dilated diameter(DD) of the left renal vein and its maximal velocity(DV) were measured and the DD/ND and NV/DV ratio were compared with those of the control children and the results of several previous reports. RESULTS: The DD/ND ratio was 3.9+/-1.89 in the GH group, 2.4+/-0.62 in the MH group, and 2.0+/-0.48 in the control group. There was a significant difference among GH, MH and control group(p<0.05). The NV/DV ratio was 3.6+/-2.37 in the GH group was significantly higher than 1.9+/-0.60 in the MH group and 1.7+/-0.55 in the control group(p<0.05). There was no significant differences between MH and control groups. Normal cut off values of DD/ND and NV/DV ratio in this study were 3.0 and 2.8 which was different to previous reports. CONCLUSION: Left renal vein entrapment phenomenon should be considered as one of the etiology of asymptomatic non-glomerular hematuria in children and the sonographic diagnostic criteria for Left renal vein entrapment syndrome needs to be revised.

The Diagnostic Value of 99mTc DMSA Renal Scan SPECT Images in Addition to Planar Image in Children with Urinary Tract Infection

PURPOSE : 99mTc DMSA renal scan have been widely used not only for the evaluation of renal scars but also for the diagnosis of acute pyelonephritis. Recent studies have shown SPECT images have higher accuracy than the planar images with some controversy. We evaluated the availability of the SPECT images adding to planar images for the diagnosis of acute pyelonephritis(APN) and renal scar in children with urinary tract infection (UTI). METHODS : 130 children with UTI (260 kidney units) and 22 follow-up children (44 kidney units) were included between January 1, 1997 and July 31, 1999 at Ewha University Mokdong Hospital. Planar Anterior and posterior images and SPECT axial and coronal images of 99mTc DMSA renal scan were obtained with Starcam 4000-i U.S.A. GE at 3 hours after 99mTc DMSA I.V. injection. The data were analyzed by Chi square test after Yates's correction. RESULTS : The detection rate of the acute pyelonephritis by SPECT images was 12.3% higher than that of planar images (47.7% vs 35.4%) by the patient and 6.9% higher also (31.9% vs 25.4%) by the kidney unit. 18 kidney units with negative planar images had focal defect in 10 kidney units (3.8%) and multifocal defect in 8 kidney units (3.1%) on SPECT images, but 1 kidney unit with positive planar image had negative SPECT image. SPECT images were superior to the planar images in 17.3%, identical in 82.3% and inferior in 0.4% to planar image. The detection rate of the renal scars by SPECT images was 13.7% higher than planar images by the patient (68.2% vs 54.5%) and 6.8% higher also (43.2% vs 36.4%) by the kidney unit. SPECT images were superior to the planar images in 17.3% and identical in 82.3% to planar image. CONCLUSION : SPECT images had shown higher detection rate and better image than planar images for the diagnosis of the acute pyelonephritis and the evaluation of the renal scars.

Effects of Umbilical Arterial Catheterization on Intestinal Hemodynamics

PURPOSE: An umbilical arterial catheter (UAC) in the high position reduces the lumen of the aorta and may thereby impair blood supply to the intestine. Effects of UAC on intestinal blood flow were investigated. METHODS: With the measurement of the aortic diameter, pulsed Doppler ultrasonography was performed in 23 fasting newborns to measure blood flow velocities (peak systolic velocity, end-diastolic velocity, mean velocity, time velocity integral and resistive index) in the celiac trunk (CT) and the superior mesenteric artery (SMA) before and after removal of the UAC in the high position. RESULTS: UAC reduced the cross-sectional area of the aorta by 3.5-15.0% (mean 7.5%), with the percentage of reduction being inversely related to birth weight (r=-0.86, P<0.0001). Blood flow velocities in the CT and the SMA did not change significantly after removal of the UACl left in place for 7 days. There were also no differences in blood flow velocities pre- and postremoval of the UAC which stayed in place for 17.3 days and caused a mean aortic obstruction of 11.7%. However, a longer indwelling time of the UAC may lead to a higher velocity in the CT with UAC in place, as reflected by a correlation by multiple regression analysis (r=0.42, P=0.045). CONCLUSION: Although UAC remaining in place for up to 2 weeks in fasting newborns does not lead to direct alterations in blood supply to the intestine, the possibility of blood flow impairment to abdominal organs by prolonged use cannot be excluded.