Hidronefrosis del recién nacido: cintigrafia renal dinámica con Tc99m MAG3 durante el primer mes de vida / Dynamic renal scintigraphy with Tc99 MAG3 for the diagnosis of newborn hydronephrosis

Background: The early and accurate diagnosis of obstructive uropathy in the newborn, prevents secondary complications and kidney damage. Aim: To study the usefulness of Tc99M MAG3 diuretic renogram in newborns with hydronephrosis. Material and methods : Forty newborns, aged 1 to 30 days, with hydronephrosis, were studied. A Tc99M MAG3 diuretic renogram (DR) was done and its results were compared with clinical features and other imaging studies. Each kidney and its ureter, were considered a renal unit. Results: Seventy six renal units were evaluated. Twenty six were normal on prenatal ultrasound examination and DR. In 11 of the 50 renal units with hydronephrosis, renal function was impaired. Thus, it was impossible to obtain an excretory curve. In 17 of the 39 remaining renal units, the absence of obstructive uropathy was demonstrated clinically. In 16 of these, the DR showed absence of obstruction. In 20 of 21 renal units with confirmed obstructive uropathy, DR showed an obstructive pattern. Conclusions : In newborns, there is an adequate Tc99M MAG3 uptake and diuretic response. Thus, DR becomes a good functional assessment method in newborns with hydronephrosis

Factores de riesgo de daño renal permanente en niños con infección del tracto urinario / Risk factors for permanent kidney damage in children with urinary tract infection

Background: In children, urinary tract infection (UTI) is a very common disease, and can cause permanent kidney damage. Aim: To determine risk factors for permanent kidney damage, in children with UTI. Patients and methods: In 337 children with UTI (237 female, mean age 4,2 years) a static renal scintigraphy was performed to assess the presence of permanent kidney damage. The history of vesicoureteral reflux and number of episodes of UTI was obtained. Results: One hundred three children had a history of one episode of infection and the rest had recurrent infections. Permanent kidney damage was observed in 161 children (48 percent). This damage was observed in 39 percent of children of less than one year of age, in 43 percent of children aged 1 to 5 years of age and in 58 percent of children older than 5 years (p=0.02). Sixty three percent of 122 children with vesicoureteral reflux had permanent kidney damage, compared with 27 percent of children without this condition (p <0.001). Likewise, damage was observed in 36 percent of children with one episode of infection and 47 percent of children with recurrent infections (p <0.01). No gender differences were observed. Conclusions: Vesicoureteral reflux, recurrence of UTI and age are associated with permanent renal damage in children with UTI

Parámetros clínicos y radiológicos de pacientes con tromboembolismo pulmonar diagnosticado a través de cintigrafías de ventilación / perfusión de alta probabilidad / Clinical and radiological parameters of patients with lung thromboembolism, diagnosed by high probability ventilation / perfusion scintigraphies

Introducción: el tromboembolismo pulmonar (TEP) es una patología compleja y de difícil enfrentamiento para el clínico, por lo que el uso de métodos de diagnóstico por imágenes se han incluido desde hace décadas en los algoritmos diagnósticos. Objetivos: establecer los parámetros clínicos y radiológicos presentes en pacientes con tromboembolismo pulmonar diagnosticado a través de cintigrafías de ventilación perfusión de alta probabilidad. Materiales y métodos: se estudió 91 pacientes a quienes se les realizó estudios cintigráficos V/Q por sospecha de TEP. Sólo se consideraron aquellas cintigrafías informadas como de alta o baja probabilidad para TEP. El promedio de edad fue de 63,1 años (rango: 20 - 89 años), 43 hombres y 48 mujeres. Resultados: existió significancia estadística para cuatro parámetros: hemoptisis (p=0,01, razón de chance=8,925), taquicardia (p=0,02, razón de chance=3,5), dolor toráxico (p=0,01, razón de chance =1,87) y la condición del postoperatorio reciente (p=0,02, razón de chance=2,762). Destacó la ausencia de hallazgos positivos en la radiografía de tórax, ya que en la gran mayoría de los casos se obtuvo una imagen normal (70,7 por ciento con valor p<0,0001). Discusión: los parámetros clínicos y radiológicos encontrados en los pacientes a los cuales se les realiza diagnóstico de TEP a través de cintigrafía V/Q fueron: dolor toráxico, hemoptisis, antecedente de postoperatorio reciente y radiografía de tórax normal. Esto es importante, ya que ayudaria a elegir al grupo de pacientes en que la cintigrafía V/Q alcanzará su mayor rendimiento