role of DMSA scan in detection of renal cortical scaring in children with urinary tract infection

Urinary tract infection [UTI] is one of the most common bacterial diseases in children, it may cause renal scars, which can lead to hypertension and renal failure. Diagnostic imaging is therefore important to detect children with scaring. Dimercaptosuccinic Acid [DMSA] is clearly more sensitive than routine renal ultrasonography or even intravenous urography for detecting renal scaring, but newer high-resolution ultrasonography is almost as sensitive as DMSA in diagnosing acute renal involvement A total number of 100 children with UTI were included in this study, their ages ranged from 2 to 12 years [35 boys, 65 girls]. They were selected from nephrology clinic and out patient clinic of pediatrics department of EL-Minia University hospital. They were divided into 2 groups depending on their ages: Group I: It included 44 patients, their ages ranged from 2 to 6 years, Group II: It included 56 patients, their ages ranged from [6-12 years], The patients were selected depending up on the presence of suggestive symptoms and signs of upper and lower UTI and positive urine culture. All patients were subjected to a thorough history taking, full clinical examination and laboratory investigations [urine analysis, urine culture, kidney function, ASOT, C-reactive protein and blood picture]. Radiologic investigation in the form of abdominal ultrasonography and DMSA scanning were done. The present study revealed that the total incidence of renal cortical scarring and diffuse photon defect [unilateral and bilateral] was 9% and 27% respectively for all patients with urinary tract infection i.e. abnormal DMSA scintigraphy represent 36%. Furthermore, there were significantly more children with abnormal DMSA and DMSA scarring among those who had upper urinary tract infection compared with those with lower urinary tract infection. DMSA scan is more reliable method than ultrasonography in detection of renal cortical scaring in cases of UTI. The clinician should be free to recommend a DMSA scan in a child with a history suggestive of acute pyelonephritis, or in cases of frequent recurrences of UTI

Necrose cortical renal em placa secundária e choque séptico por colangite / Cortical necrosis secondary to cholangitis and septic shock

Atualmente, a necrose cortical é uma causa rara de insuficiência renal aguda. Sua freqüência tem sido cada vez menor, principalmente nos países desenvolvidos, em decorrência do menor número de casos de insuficiência renal aguda associados à gestação. Neste artigo, é descrito um caso de necrose cortical em placas, secundária a choque séptico por colangite e feita uma revisão da literatura pertinente.

Necrosis cortical renal: presentación de un caso / Renal cortical necrosis: case presentation

Se informa un caso de necrosis cortical renal, que se diagnosticó en el Hospital Escuela. Esta patología no es común. Tradicionalmente asociada a condiciones de embarazo. Sin embargo, ahora se le atribuyen a la sépsis, venenos de serpientes, quimioterapia, drogas o efectos secundarios de medicamentos, como las causas más frecuentes. Es todavía una condición médica que tiene un alto porcentaje de mortalidad y que presenta varias limitaciones para su diagnóstico temprano

Necrosis renal cortical aguda / Acute renal cortical necrosis

La necrosis renal cortical aguda (NRCA) es la destrucción parcial o total de todos los elementos de la corteza renal. Se caracteriza por oliguria prolongada y recuperación incompleta de la función renal. Se ha implicado al vasoespasmo y a la liberación de toxinas en los eventos fisiopatológicos que producen esta enfermedad. Las causas más comunes de ARCN son complicaciones del enbarazo, síndrome urémico hemolítico, pancreatitis, sepsis, quemaduras, trauma, mordeduras de serpientes, shock y rechazo de injertos. La mortalidad es muy alta y muchos de los sobrevivientes requieren substitución permanente de la función renal

Bilateral renal cortical necrosis with the changes in clinical features over the past 15 years (1980-1995)

A rare case of bilateral renal cortical necrosis (BRCN) diagnosed only by the characteristic and specific findings of a contrast-enhanced CT scan during the acute initial phase of the disease is presented in this paper. Furthermore, twenty-eight patients of BRCN in the world literatures in English after 1980 were analyzed to investigate the changes in its clinical features over the past 15 years in comparison with the reported data before 1980 from two large centers in France (F) and India (I). Obstetric causes decreased from 68% (F) and 71% (I) before 1980 to 28% after 1980, whereas nonobstetric causes increased from 32% (F) and 29% (I) to 72% after 1980. Among the nonobstetric causes of BRCN, the leading causes were sepsis in 4 out of 12 patients (F) and snake bite in 6 out of 14 patients (I) before 1980, but, in contrast, drugs in 4 out of 21 patients after 1980. As a definite diagnostic procedure for BRCN, 95 to 100% before 1980 but 86% after 1980 performed renal biopsy, of which renal biopsy while living was done in only 42% (F) and 16% (I) before 1980 and 67% after 1980. None showed renal calcification in abdominal X-ray, and only 25% (3/12) had nonspecific echo findings in renal ultrasonography, whereas the high sensitivity for BRCN was noted in renal arteriography in 100% (6/6) and contrast-enhanced CT scan in 88% (7/8). The mortality of BRCN decreased from 55% (F) and 86% (I) before 1980 to 36% after 1980. This review of BRCN, in conclusion, revealed the distinctive changes over the past 15 years in the etiology with a higher incidence of non-obstetric causes than obstetric ones, diagnostic procedures with less dependence on renal biopsy but new trials of non-invasive radioimagings including CT scan and even MRI, and a further declining mortality rate.