PieloRM: una nueva herramienta en el estudio de pielonefritis aguda en pediatría / PyeloMR (PieloRM): a new tool in the study of acute pyelonephritis in children

Para determinar la existencia de compromiso parenquimatoso renal en infección del tracto urinario en niños, la tendencia actual es utilizar métodos de imágenes lo menos invasivos posibles, disminuyendo al máximo la exposición a radiación ionizante. La resonancia magnética ha demostrado utilidad en la pesquisa de pielonefritis aguda. Desarrollamos por esto un protocolo de resonancia magnética (PieloRM), que permite de manera rápida, segura y no invasiva detectar compromiso inflamatorio parenquimatoso renal, eventuales complicaciones y alteraciones anatómicas preexistentes. Se utilizan secuencias anatómicas potenciadas en T2 y difusión en los planos axial y coronal en el eje largo de los riñones, sin contraste endovenoso ni anestesia, con técnica de privación de sueño, abrigar y alimentar en lactantes y niños más pequeños. La duración total del examen no sobrepasa los 15 minutos.

Current trend to determine kidney involvement in urinary tract infection in children consider less invasive and lower radiation exposure. Magnetic resonance has been reported has a useful tool in acute pyelonephritis suspicion. We developed a fast, safety, non-contrast magnetic resonance protocol to detect renal parenchymal inflammatory changes in children. Complications and anatomical alterations were also possible to be evaluated. Axial and coronal T2-weighted images for anatomical characterization and diffusion weighted images were obtain for kidney representation. Feed and wrap technique and sleep deprivation, with non-additional sedation or anesthesia was used in a 15 minutes total examination protocol.

The combination of urinary IL - 6 and renal biometry as useful diagnostic tools to differentiate acute pyelonephritis from lower urinary tract infection

ABSTRACT Objective: To evaluate the role of renal ultrasound (RUS) and urinary IL-6 in the differentiation between acute pyelonephritis (APN) and lower urinary tract infection (LUTI). Patients and methods: This prospective study was carried out at the Pediatric and urology outpatient and inpatient departments of Cairo University Children's Hospital as well as October 6 University Hospital and it included 155 children between one month and fourteen years old with positive culture UTI. Patients were categorized into APN and LUTI based on their clinical features and laboratory parameters. Thirty healthy children, age and sex matched constituted the control group. Children with positive urine cultures were treated with appropriate antibiotics. Before treatment, urinary IL-6 was measured by enzyme immunoassay technique (ELISA), and renal ultrasound (RUS) was done. CRP (C-reactive protein), IL-6 and RUS were repeated on the 14th day of antibiotic treatment to evaluate the changes in their levels in response to treatment. Results: UIL-6 levels were more significantly higher in patients with APN than in patients with LUTI (24.3±19.3pg/mL for APN vs. 7.3±2.7pg/mL in LUTI (95% CI: 2.6-27.4; p<0.01). Similarly, serum CRP was more significantly higher in patients with APN than in children with LUTI (19.7±9.1μg/mL vs. 5.5±2.3μg/mL (p<0.01). IL-6 levels >20pg/mL and serum CRP >20μg/mL were highly reliable markers of APN. Mean renal volume and mean volume difference between the two kidneys in the APN group were more than that of the LUTI and control groups (P<0.001). Renal volume between 120-130% of normal was the best for differentiating APN from LUTI. Conclusions: RUS and urinary IL-6 levels have a highly dependable role in the differentiation between APN and LUTI especially in places where other investigations are not available and/ or affordable.

Emphysematous pyelonephritis: a case report

Emphysematous pyelonephritis is a severe, acute necrotizing renal parenchymal and perirenal infection with formation of gas. Emphysematous pyelonephritis predominantly affects females with uncontrolled diabetes and can occur in insulin-dependent as well as non-insulin dependant patients. CT scan is the modality of choice for the staging of the parenchymal gas and to rule out obstruction. We present a case of 83-year old female with uncontrolled diabetes mellitus who presented with dysu-rea and right flank pain in the emergency department. She was diagnosed as a case of emphysematous pyelonephritis. She was treated successfully in the urology department by antibiotics and percutaneous drainage

[Diagnostic value of power doppler sonography in acute pyelonephritis in children]

Urinary tract infection is common in pediatric age group and can result in serious complications such as chronic renal failure and hypertension if renal parenchyma is involved. Thus, definitive diagnosis of pyelonephritis in equivocal cases is of great importance. Comparing the diagnostic value of power color Doppler sonography and DMSA scan in acute pyelonephritis in children. This was a descriptive study carried out on 80 pediatric patients [160 renal units] suspected of having pyelonephritis. Two diagnostic methods [DMSA scan and power color Doppler sonography] were performed for all patients. Assuming DMSA scan as the gold standard method in diagnosis of acute pyelonephritis, the sensitivity, specificity, positive and negative predictive values and also the accuracy of power color Doppler sonography were calculated and analyzed, statistically. Power color Doppler sonography showed a sensitivity of 66.3%, specificity of 77.5%, positive predictive value of 78.7%, and negative predictive value of 64.7% with an accuracy of 71.3% in diagnosis of acute pyelonephritis in children. The agreement between the two diagnostic tests was shown to be around 43%. Based on our data, the power color Doppler sonography of kidneys has lower sensitivity and specificity compared to those obtained by DMSA scan in diagnosing acute pyelonephritis in children and is not considered as an ideal diagnostic technique for this particular clinical condition

Medicina nuclear en el tracto nefrourinario / Nuclear medicine in the nephrourinary tract

Nuclear medicine images play an important role in the evaluation of urinary tract pathologies. Radionuclide imaging studies (DMSA scan, DTPA/MAG3 renography, radionuclide cistography) are reviewed, analyzing their indications.

En el diagnóstico por imágenes de las enfermedades del sistema nefrourológico, la Medicina Nuclear juega un rol importante en determinadas patologías. Se revisan los diferentes exámenes empleados en la actualidad: cintigrafía renal DMSA, renograma isotópico DTPA/MAG3, cistografía isotópica y se analizan sus principales indicaciones.