Comparison of the relative renal function evaluated by 99Tcm-DMSA and 99Tcm-DTPA imaging in children with acute urinary tract infection / 中华核医学与分子影像杂志

Objective@#To compare the relative renal function (RRF) evaluated by 99Tcm-dimercaptosuccinic acid (DMSA) and 99Tcm-diethylene triamine pentaacetic acid (DTPA) imaging in children with acute urinary tract infection (UTI).@*Methods@#A total of 69 children (29 males, 40 females, age: (45±38) months; duration of disease: <6 months) with acute UTI diagnosed clinically in Wuxi People′s Hospital from January 2017 to June 2019 were enrolled retrospectively. All children underwent 99Tcm-DMSA renal static imaging and 99Tcm-DTPA renal dynamic imaging, and the regions of interest (ROI) were drawn manually to calculate the RRF of the right and left kidneys. The consistency of RRF evaluated by the two imaging methods was analyzed by Bland-Altman analysis, the correlation was analyzed by Pearson correlation analysis, and the difference was compared by the independent-sample t test.@*Results@#The values of RRF measured with 99Tcm-DMSA and 99Tcm-DTPA were (52.27±14.53)% and (52.22±14.14)% for the left kidney (t=0.913, P>0.05), those for the right kidney were (47.73±14.53)% and (47.78±14.14)% (t=0.913, P>0.05), respectively. A significant positive correlation was found between the RRF measured with the two imaging methods both for left and right kidneys (r values: 0.959, 0.959; both P<0.01). Bland-Altman analysis showed that the average difference of RRF measured with the two imaging methods for left kidney was 0.1% and the 95% limits of agreement (LoA) was from -8.0% to 8.1%, those for right kidney were -0.1% and from -8.1% to 8.0%.@*Conclusions@#There is a good correlation between RRF measured with 99Tcm-DMSA renal static imaging and that measured with 99Tcm-DTPA renal dynamic imaging in children with acute UTI. Both imaging methods can be used to evaluate the RRF in children with acute UTI.

Comparison of the relative renal function evaluated by 99 Tcm-DMSA and 99 Tcm-DTPA imaging in children with acute urinary tract infection / 中华核医学与分子影像杂志

Objective To compare the relative renal function (RRF) evaluated by 99 Tcm-dimer-captosuccinic acid (DMSA) and 99 Tcm-diethylene triamine pentaacetic acid (DTPA) imaging in children with acute urinary tract infection (UTI). Methods A total of 69 children (29 males, 40 females, age:(45±38) months; duration of disease: <6 months) with acute UTI diagnosed clinically in Wuxi People's Hospital from January 2017 to June 2019 were enrolled retrospectively. All children underwent 99 Tcm-DMSA renal static imaging and 99 Tcm-DTPA renal dynamic imaging, and the regions of interest (ROI) were drawn manually to calculate the RRF of the right and left kidneys. The consistency of RRF evaluated by the two im-aging methods was analyzed by Bland-Altman analysis, the correlation was analyzed by Pearson correlation analysis, and the difference was compared by the independent-sample t test. Results The values of RRF measured with 99 Tcm-DMSA and 99 Tcm-DTPA were (52.27±14.53)％ and (52.22±14.14)％ for the left kidney (t= 0.913, P>0.05), those for the right kidney were (47.73±14.53)％ and (47.78±14.14)％ (t=0.913, P>0.05), respectively. A significant positive correlation was found between the RRF measured with the two imaging methods both for left and right kidneys (r values: 0.959, 0.959; both P<0.01). Bland-Altman analysis showed that the average difference of RRF measured with the two imaging methods for left kidney was 0.1％ and the 95％ limits of agreement (LoA) was from -8.0％ to 8.1％, those for right kidney were -0.1％and from -8.1％ to 8.0％. Conclusions There is a good correlation between RRF measured with 99Tcm-DMSA renal static imaging and that measured with 99 Tcm-DTPA renal dynamic imaging in children with acute UTI. Both imaging methods can be used to evaluate the RRF in children with acute UTI.

The role of fetal-maternal microchimerism as a natural-born healer in integrity improvement of maternal damaged kidney

ABSTRACT Purpose: To identify the fetal stem cell (FSC) response to maternal renal injury with emphasis on renal integrity improvement and Y chromosome detection in damaged maternal kidney. Materials and Methods: Eight non-green fluorescent protein (GFP) transgenic Sprague-Dawley rats were mated with GFP-positive transgenic male rats. Renal damage was induced on the right kidney at gestational day 11. The same procedure was performed in eight non-pregnant rats as control group. Three months after delivery, right ne- phrectomy was performed in order to evaluate the injured kidney. The fresh perfused kidneys were stained with anti-GFP antibody. Polymerase chain reaction (PCR) assay was also performed for the Y chromosome detection. Cell culture was performed to detect the GFP-positive cells. Technetium-99m-DMSA renal scan and single-photon emission computed tomography (SPECT) were performed after renal damage induction and 3 months later to evaluate the improvement of renal integrity. Results: The presence of FSCs was confirmed by immune histochemical staining as well as immunofluorescent imaging of the damaged part. Gradient PCR of female rat purified DNA demonstrated the presence of Y-chromosome in the damaged maternal kidney. Moreover, the culture of kidney cells showed GPF- positive cells by immuno- fluorescence microscopy. The acute renal scar was repaired and the integrity of dam- aged kidney reached to near normal levels in experimental group as shown in DMSA scan. However, no significant improvement was observed in control group. Conclusion: FSC seems to be the main mechanism in repairing of the maternal renal injury during pregnancy as indicated by Y chromosome and GFP-positive cells in the sub-cultured medium.

Which Factors Related to the Renal Cortical Defects in Infants Under 3 Months of Age with Urinary Tract Infections?

PURPOSE: We used technetium-99m dimercaptosuccinic acid (DMSA) scintigraphy to identify factors predictive of renal cortical defects in infants <3 months of age with urinary tract infections (UTIs). METHODS: We retrospectively reviewed data on infants <3 months of age with culture-proven UTIs treated at a single center from March 2010 to February 2016. Blood samples were obtained for laboratory evaluation prior to commencement of antibiotic therapy. The therapeutic delay time (TDT) and therapeutic response time (TRT) were recorded. All patients were divided into two groups depending on features of their DMSA scans. We compared the demographic, clinical, and laboratory characteristics of the two groups. RESULTS: A total of 119 infants (94 males and 25 females; mean age, 56.9±21.3 days) were included. Cortical defects were evident in the DMSA scans of 47 cases (39.5%). In infants with such defects, the peak temperatures (38.9±0.57℃ vs. 38.4±0.81℃, P=0.001), the absolute neutrophil counts (8,920±4,460/mm vs. 7,290±4,090/mm, P=0.043), and the C-reactive protein (CRP) levels (6.49±4.33 mg/dL vs. 3.21±2.81 mg/dL, P=0.001) were significantly higher than those in infants without cortical defects. The TDT was also longer in those with cortical defects (P=0.037). CONCLUSION: We found that a TDT ≥8.5 hr (odds ratio [OR] 5.81), a peak temperature ≥38.3℃ (OR 6.19), and a CRP level ≥4.96 mg/dL (OR 7.26) predicted abnormal DMSA scan results in infants <3 months of age with UTIs.

Influence of Annona muricata (soursop) on biodistribution of radiopharmaceuticals in rats

To evaluate the effect of hydroalcoholic extract of A. muricata on biodistribution of two radiopharmaceuticals: sodium phytate and dimercaptosuccinic acid (DMSA), both labeled with 99mtechnetium. METHODS: Twenty four Wistar rats were divided into two treated groups and two controls groups. The controls received water and the treated received 25mg/kg/day of A. muricata by gavage for ten days. One hour after the last dose, the first treated group received 99mTc-DMSA and the second sodium 99mTc-phytate (0.66MBq each group), both via orbital plexus. Controls followed the same protocol. Forty min later, all groups were sacrificed and the blood, kidney and bladder were isolated from the first treated group and the blood, spleen and liver isolated from the second treated group. The percentage of radioactivity per gram of tissue (%ATI/g) was calculated using a gamma counter. RESULTS: The statistical analysis showed that there was a statistically significant decrease (p<0.05) in the uptake of %ATI/g in bladder (0.11±0.01and1.60±0.08), kidney (3.52±0.51and11.84±1.57) and blood (0.15±0.01and 0.54±0.05) between the treated group and control group, respectively. CONCLUSION: The A. muricata hydroalcoholic extract negatively influenced the uptake of 99mTc-DMSA in bladder, kidney and blood of rats.

Abnormal Dimercaptosuccinic Acid Scan May Be Related to Persistence of Vesicoureteral Reflux in Children with Febrile Urinary Tract Infection

PURPOSE: This study assessed whether 99mtechnetium dimercaptosuccinic acid (DMSA) scintigraphy used for the assessment of renal sequelae after febrile urinary tract infection (UTI) has any prognostic value for outcome measurement of vesicoureteral reflux (VUR) by retrospectively evaluating the correlation between abnormal DMSA scintigraphy results and persistence of VUR in children with febrile UTI. MATERIALS AND METHODS: The medical records of 142 children (57 boys, 85 girls) admitted with febrile UTI from January 2004 to December 2006 and who were followed up for more than 1 year were retrospectively reviewed. At the initial and follow-up visits, renal ultrasound and DMSA scans were performed within 7 days from the diagnosis and voiding cystourethrography (VCUG) was performed within 1 month in all case and follow-up evaluations. RESULTS: The children's mean age was 4.8+/-3.6 years (range, 0.3 to 14 years). The mean follow-up was 28.2+/-4.8 months. At the initial examination, VUR was more often associated with an abnormal DMSA scan result (83.3%) than with a normal DMSA scan result (16.7%, p=0.02). The frequency of VUR with an abnormal DMSA scan during acute UTI was significantly higher than the frequency of VUR with a normal DMSA scan (38.8% vs, 25.8%, respectively, p=0.004). Also, high-grade VUR was associated with an abnormal DMSA scan result (32.5%) more often than with a normal DMSA scan result (0%, p=0.01). Children with an abnormal DMSA scan had a lower resolution rate of VUR (17.5%) than did children with a normal DMSA scan (75.0%) at the follow-up VCUG (p=0.02). CONCLUSIONS: An abnormal result on a DMSA scan during febrile UTI is associated with high-grade and persistent VUR. DMSA scans performed during febrile UTI are useful in reflux resolution in childhood.

The Effect of Renal Scarring on Spontaneous Resolution and Breakthrough Infection in Children with Vesicoureteral Reflux

PURPOSE: Primary treatment of children with vesicoureteral reflux (VUR) is antibiotic prophylaxis until the reflux resolves. But, it is not easy to determine in which patients the reflux resolves. We sought to determine whether renal scarring could help to predict the prognosis of reflux regarding reflux resolution and breakthrough infection. MATERIALS AND METHODS: A total of 90 children, 54 boys and 36 girls, mean age 15.1 (range: 1-98) months, with VUR were analyzed retrospectively. Eighty-six presented with febrile urinary tract infection (UTI) and 4 with prenatal hydronephrosis. Technetium Tc 99m dimercaptosuccinic acid (DMSA) scans were performed at 4 months after resolution of a febrile UTI. All children were initially treated with antibiotic prophylaxis (Bactrim(R); TMX-SMX 2 mg/kg/day) and 40 underwent antireflux surgery. Median follow-up was 26.1 (range: 6-52) months. Reflux grade was defined by use of the International Classification System. We analyzed the incidence of renal scarring according to reflux grade, reflux resolution, and reason for antireflux surgery. RESULTS: Normal DMSA scans were documented in 63 (70%) children and renal scarring in 27 (30%). Children with renal scarring presented high grade (III-V) VUR. VUR with renal scarring was not resolved spontaneously and increased the risk for breakthrough UTI. Renal scarring could help to predict the prognosis of reflux regarding reflux resolution and breakthrough infection. VUR grade, however, did not help to predict the prognosis of reflux. CONCLUSIONS: We conclude that VUR with renal scarring has a low spontaneous resolution rate and a high risk for breakthrough UTI. This information would be helpful when counseling the families of patients with VUR.

Age-related Radiological Imaging in Children with Acute Pyelonephritis / 대한비뇨기과학회지

PURPOSE: The accurate diagnosis of acute pyelonephritis(APN) using clinical and laboratory parameters is often difficult in children. The 99mTc-dimercaptosuccinic acid (DMSA) renal scan is utilized as a gold standard for renal involvement, and renal ultrasonography(RUS) and voiding cystourethrography(VCUG) are utilized to evaluate underlying urinary tract anomalies. In this study the radiological imaging in children of different age groups, with clinical APN, were retrospectively compared. MATERIALS AND METHODS: Between May 1994 and April 2002, 375 children presented with a febrile urinary tract infection(UTI), and had a DMSA renal scan. Of the patients, 270 had RUS and 220 had contrast VCUG. The sensitivity of these tests in febrile UTI in three age groups was determined: group I less than 2 years; group II 2-5 years; group III older than 5 years. RESULTS: The clinical and laboratory manifestations of APN correlated better with a positive DMSA renal scan in the older children than in the younger children; 76.1% of the DMSA renal scans were positive in group III; 68.3% in group II; 50.8% in group I(p<0.05). RUS had no correlation with a positive DMSA renal scan in any of the age groups. Vesicoureteral reflux was more prevalent in the older age groups. High grades of reflux(grade IV-V) correlated better with positive DMSA renal scans(p<0.05). CONCLUSIONS: This study demonstrates that the clinical and laboratory manifestations of APN do not correlate with the findings of DMSA renal scans in young children. Therefore, a young child with a clinical suspicion of APN should be evaluated by a DMSA renal scan to confirm renal parenchymal involvement.