Investigation of the Effects of N-acetylcysteine and Selenium on Vesicoureteral Reflux Nephropathy: An Experimental Study.

INTRODUCTION: This study aimed to investigate the effects of N-acetylcysteine (NAC) and selenium (Se) on vesicoureteral reflux (VUR) nephropathy. METHODS: A total of 44 rabbits in 7 groups, namely group 1 (Control), group 2 (VUR + sterile urine), group 3 (VUR + sterile urine + NAC), group 4 (VUR + sterile urine + Se), group 5 (VUR + infected urine), group 6 (VUR + infected urine + NAC) and group 7 (VUR + infected urine + Se), were used. 99mTc Dimercaptosuccinic acid renal scan (DMSA), cystogram and urine culture were performed both at the beginning and end of the study. Left VUR was created surgically, and E. coli was inoculated in infected urine groups. NAC and Se were administered daily for 21 days. Malondialdehyde (MDA) measurement, inflammatory response scores (IRSs), and cicatrization response scores (CRSs) in renal tissues were evaluated. RESULTS: VUR did not reduce left renal uptake values in neither group 2 nor group 5. MDA levels of the left kidney were significantly higher in group 5 compared to group 1 (p = 0.001). There was no significant difference in MDA levels between group 5 and group 6, and between group 5 and group 7. Left kidney IRSs were found to be higher in all other groups except group 2 compared to the control group (p < 0.001). Left kidney CRSs were significantly higher in group 5 compared to group 2 (p = 0.026), group 6 (p < 0.001) and group 7 (p = 0.006). CONCLUSION: A decrease in renal functions was not observed in VUR, even if there was infection. When CRSs were evaluated, NAC and Se had protective effects in terms of scar formation in VUR nephropathy. TYPE OF STUDY: Experimental animal study. LEVELS OF EVIDENCE: N/A.

99mTc-DMSA and 99mTc-DTPA identified renal dysfunction due to microplastic polyethylene in murine model.

In the previous study (Im et al., 2022), we revealed microplastic (MP) was accumulated and cleared through the kidneys via PET imaging. Here, we aimed to identify the renal dysfunction due to polyethylene (PE) MP in the kidney tissue. Mice were exposed to 100 ppm (∼equivalent to 0.1 mg/mL)/100 µL of PE for 12 weeks (n = 10). PE uptake in the kidney tissues was confirmed using confocal microscopy. QuantSeq analysis was performed to determine gene expression. Renal function assessment was performed using 99mTc-Diethylene triamine penta acetic acid or 99mTc-Dimercaptosuccinic acid. Measurement of creatinine, BUN, and albumin levels in serum and urine samples was also estimated. [18F]-FDG was also acquired. PE increased expression of Myc, CD44, Programmed Death-Ligand 1 (PD-L1), and Hypoxia-Inducible Factor (HIF)-1α, which indicates a potential link to an increased risk of early-onset cancer. An increase in glucose metabolism of [18F]-FDG were observed. We assessed renal failure using 99mTc-Diethylene triamine penta acetic acid and 99mTc-Dimercaptosuccinic acid scintigraphy to determine the renal function. Renal failure was confirmed using serum and urine creatinine, serum blood urea nitrogen levels, serum albumin levels, and urine albumin levels in PE exposed mice, relative to the control. In sum, PE exposure induced renal dysfunction in a murine model.

How the 99mTc-DMSA scintigraphy findings are reflected in the adopted treatment of primary vesicoureteral reflux: One centre experience.

BACKGROUND: Renal changes may have long-term sequalae and prevention is a main goal of management of primary vesicoureteral reflux (VUR). AIM: This study aims to reveal how much 99mTc-DMSA scintigraphy findings are reflected in the adopted surgical or non-surgical treatment in children with diagnosed primary VUR and to give the clinicians information regarding their final therapeutic decision. PATIENTS AND METHODS: A total 207 children with primary VUR who underwent non-acute 99mTc-DMSA scan were retrospectively evaluated. The presence of renal changes, their grading, differential function asymmetry (<45%) and grade of VUR were compared with subsequent choice of therapy. RESULTS: Altogether 92 (44%) children had asymmetric differential function, 122 (59%) showed presence of renal changes, 79 (38%) had high-grade VUR (IV-V). Patients with renal changes had lower differential function (41%vs.48%) and higher grade of VUR. The incidence of high-grade changes (G3+G4B) afflicting more than one third of the kidney was significantly different between grade I-II, III and IV-V VUR (9%, 27%, 48%, respectively). Renal changes were detected in 76% of surgically and 48% of non-surgically treated patients, high-grade 99mTc-DMSA changes in 69% and 31%, respectively. In children with no scars/dysplasia (G0+G4A), non-surgical treatment prevailed in 77%. The independent predictors for surgical intervention were presence of renal changes and higher grade of VUR, but not functional asymmetry. DISCUSSION: Over the last 20 years, there has been a shift toward more non-surgical management of VUR. The long-term outcome of this approach should be thoroughly studied. This is the first study analysing renal status in VUR patients using 99mTc-DMSA scan and its grading regarding the adopted treatment. Renal changes in almost half of non-surgically treated children with VUR should be an indicator for earlier diagnosis and effective treatment of acute pyelonephritis and VUR. We recommend distinguishing grade III VUR, as a moderate-grade VUR, because it is linked to higher incidence of high-grade 99mTc-DMSA changes (G3+G4B); our findings of 65% of grade III VURs treated non-surgically should be cautionary. Grade III VUR does not mean a low-risk condition and should alert the clinician to evaluate the extent of renal changes and unmask high-risk cases. CONCLUSIONS: Our data strengthens the need to investigate the extent of renal changes in VUR patients regarding treatment decision. Performing 99mTc-DMSA scan individualizes the treatment of VUR patients; its grading can distinguish grade III-VUR as a separate risk entity because it differs significantly in terms of incidence of high-grade renal changes and chosen therapy.

Calculation of absorbed dose in paediatric phantoms using Monte Carlo techniques for 18F-FDG and 99mTc-DMSA and the new TIAC.

The radiopharmaceuticals most commonly used in nuclear medicine are 18F-FDG and 99mTc-DMSA, both of which are administered to paediatric and adult patients using the same time activity coefficient. However, the IAEA recommends specific paediatric dosimetry. The aim of this work (TW) was to estimate the absorbed dose for 18F-FDG and 99mTc-DMSA using two paediatric voxel phantoms (Baby and Child) by Monte Carlo techniques. Biokinetic data for both radiopharmaceuticals were obtained from ICRP 128. In addition, the new time-integrated activity coefficient (TIAC) values from a recent publication were examined for the following organs: Brain, urinary bladder wall, liver, heart wall, and lung. The absorbed dose per injected activity (AD/IA) and effective dose per injected activity (E/IA) values were calculated for both phantoms and the results were compared with simulated data of paediatric phantoms from ICRP 128, MIRDcalc software and available literature. Regarding AD/IA in organs, differences of up to 61% and 115% were found for the Baby phantom and 120% and 167% for the Child phantom using 18F-FDG and 99mTc-DMSA, respectively. For FDG using the new TIAC, a maximum difference of 244% was observed. For E/IA, the maximum differences were 27% and 31% for the Baby and Child phantoms, respectively, for FDG and DSMA. In this study, new dosimetric data were calculated using Baby and Child phantoms and the newly recommended TIAC.

Comparison of 2D planar and 3D volumetric methods for estimation of split renal function by 99mTc-DMSA scintigraphy.

PURPOSE: Split renal function (SRF) can be measured by using several methods in 99mTc-DMSA scintigraphy. Geometric mean (GM) based methods derived from planar images(2D) have been used for several years, besides; 3D-methods were also reported as an option for assessment of SRF. The purpose of this study to compare 2D and 3D methods for calculation of SRF in pediatric and adult patients. METHODS: We evaluated 212 patients, underwent both planar and SPECT 99mTc-DMSA scintigraphy.2D-SRFs were calculated by GM without background correction (SRFnobcg), GM with background correction in crescent formation from lower lateral borders (SRFcres), and GM with background correction in circumferential formation, including the whole kidney surroundings (SRFcirc). In 3D settings, SRF was measured with SPECT (SRFspect). Paired t-test was used to compare the mean SRFs of each group. Bland-Altman method was used as an agreement method for each method. Analyses were performed based on left kidney SRFs. RESULTS: In comparison of 2D and 3D methods, SRFspect was significantly different from SRFnobcg and SRFcres (p=<0.001) but not from SRFcirc (p = 0.155) in all patients. Similar results were found for patients with high creatinine level, SRFcirc and SRFspect were not significantly different (p = 0.317), while significant differences were found between SRFspect and SRFnobcg/SRFcres (p=<0.001).On the other hand, all 2D-methods showed statistical differences (p=<0.001-0.026) from 3D-method in pediatric patients. Bland-Altman-plot demonstrated that SRFcirc underestimated the poor functioning kidneys. CONCLUSION: SRFcirc can be used in measurement of SRF in adult patients with normal functioning kidneys in busy clinics. However, SRFspect provides more accurate results and suggested particularly for pediatric patients and poor functioning kidneys.

Assessment of drug transporters involved in the urinary secretion of [99mTc]dimercaptosuccinic acid.

INTRODUCTION: We clarified the renal uptake and urinary secretion mechanism of [99mTc]dimercaptosuccinic acid ([99mTc]DMSA) via drug transporters in renal proximal tubules. METHODS: [99mTc]DMSA was added to human embryonic kidney 293 cells expressing human multidrug and toxin extrusion (MATE)1 and MATE2-K, carnitine/organic cation transporter (OCTN)1 and OCTN2, and organic cation transporter (OCT)2; to Flp293 cells expressing human organic anion transporter (OAT)1 and OAT3; and to vesicles expressing P-glycoprotein (P-gp), multidrug resistance associated protein (MRP)2, MRP4, or breast cancer resistance protein with and without probenecid (OAT inhibitor for both OATs and MRPs). Time activity curves of [99mTc]DMSA with and without probenecid were established using LLC-PK1 cells. Biodistribution and single photon emission computed tomography (SPECT) imaging in mice were conducted using [99mTc]DMSA with and without probenecid. RESULTS: [99mTc]DMSA uptake was significantly higher in Flp293/OAT3 than in mock cells. Uptake via OAT3 was inhibited by probenecid. [99mTc]DMSA uptake into vesicles that highly expressed MRP2 was significantly higher in adenosine triphosphate (ATP) than in adenosine monophosphate (AMP), and probenecid decreased uptake to similar levels as that in AMP. In the time activity curves for [99mTc]DMSA in LLC-PK1 cells, probenecid loading inhibited accumulation from the basolateral side into LLC-PK1 cells, whereas accumulation from the apical side into cells gradually increased. Transport of [99mTc]DMSA from both sides was low. Biodistribution and SPECT imaging studies showed that [99mTc]DMSA with probenecid loading resulted in significantly higher accumulation in blood, heart, liver, and bladder after [99mTc]DMSA injection compared with control mice. Probenecid induced significantly lower accumulation in the kidney after [99mTc]DMSA injection. CONCLUSIONS: [99mTc]DMSA accumulates in renal proximal tubular epithelial cells from blood via OAT3 on the basolateral side, and then a small volume of [99mTc]DMSA will be excreted in urine via MRP2. ADVANCES IN KNOWLEDGE: [99mTc]DMSA accumulates via OAT3 in renal proximal tubular epithelial cells and is slightly excreted from the cells via MRP2. IMPLICATIONS FOR PATIENT CARE: [99mTc]DMSA may be useful for measuring renal transport function with OAT3 in patients.

99mTc-DMSA Scintigraphy Revealed A Unilateral Multicystic Anomaly In A Horseshoe Kidney.

The multicystic dysplastic pattern in a half of a horseshoe kidney is a very uncommon presentation. We present a 6-month-old male infant with a history of antenatally unilateral cystic abnormality in the right kidney which was reevaluated after birth by ultrasonography (US) and 99m Tc-DMSA scintigraphy. The US showed a horseshoe kidney with the multicystic dysplastic area on the right side, which proved to be non-functional on 99m Tc-DMSA scintigraphy.

Diffusion-weighted magnetic resonance imaging is more sensitive than dimercaptosuccinic acid scintigraphy in detecting parenchymal lesions in children with acute pyelonephritis: A prospective study.

INTRODUCTION: Static renal scintigraphy is the gold standard for detection of inflammatory changes in the renal parenchyma in acute pyelonephritis. Our aim was to determine whether diffusion-weighted magnetic resonance imaging (DW-MRI) was comparable with static renal scintigraphy (DMSA-SRS) to demonstrate acute renal parenchymal lesions. OBJECTIVE: To compare 99mTc-dimercaptosuccinic acid static renal scintigraphy (DMSA-SRS) with diffusion-weighted magnetic resonance imaging (DW-MRI) for detecting acute inflammatory changes in the renal parenchyma in children with febrile urinary tract infection. METHODS: Thirty-one children (30 girls) aged 3-18 years with a first episode of febrile UTI without a previously detected congenital malformation of the urinary tract, were prospectively included. DMSA-SRS and DW-MRI were performed within 5 days of diagnosis to detect renal inflammatory lesions. The DW-MRI examination was performed without contrast agent and without general anesthesia. Late examinations were performed after 6 months using both methods to detect late lesions. RESULTS: DW-MRI confirmed acute inflammatory changes of the renal parenchyma in all 31 patients (100%), mostly unilateral. DMSA-SRS detected inflammatory lesions in 22 children (71%; p = 0.002). The lesions were multiple in 26/31 children (84%) on DW-MRI and in 9/22 (40%) on DMSA-SRS. At the control examination, scarring of the renal parenchyma was found equally by DW-MRI and DMSA-SRS in five patients (16%), three of whom were the same patients. The overall concordance of positive and negative late findings occurred in 87% of patients. There was correspondence in the anatomical location of acute and late lesions. DISCUSSION: The clinical significance of acute and late parenchymal findings on DWI-MR is yet to be determined. A limitation of our study is the age of the patients (older than 3 years) who are less sensitive to scar development; therefore, a smaller number of patients with scars could be analyzed during control examination. Further studies using the DW-MRI should confirm its reliability to detect acute and late lesions in younger children and infants and determine the clinical consequences. CONCLUSION: DW-MRI has higher sensitivity for detecting acute renal inflammatory lesions and multifocal lesions than DMSA-SRS. The incidence of scars was low and corresponded with the anatomical location of acute and late lesions.

Comparison of relative renal functions calculated with 99mTc-DTPA and 99mTc-DMSA for kidney patients of wide age ranges.

Renal scintigraphy is an imaging method that uses small amount of radioactive materials called radiotracers, a Gamma camera and a computer to evaluate kidney functions and its anatomy. The present work reports the comparison of the relative renal functions (RRF) calculated with technetium-99m dimercaptosuccinic acid (99mTc­DMSA) and technetium-99m diethylenetriaminepentaacetic acid (99mTc­DTPA) for kidney patients of ages between 5 months and 71 years. A total of 50 patients including 29 male and 21 female has been selected and studied for renography. The mean RRFs have been found to be 52.68 ±â€¯23.63% and 47.32 ±â€¯23.63% respectively for the left and right kidneys with 99mTc-DMSA measurement. With 99mTc-DTPA the values are 52.74 ±â€¯23.54% and 47.26 ±â€¯23.54% for the same. In bivariate correlation analysis, a significant positive correlation (r = 0.996, P < .001) has been found between the RRFs calculated with the two methods. Following the patients' diagnosis, in ANOVA test, no difference has been found between the RRFs calculated for the left and right kidneys. In Bland-Altman plots, the mean difference between the two methods has been found to be 0.1 and the correlation limit lies between -4.3 and 4.2. According to the result obtained in the present work, both the 99mTc-DMSA and 99mTc-DTPA scanning methods provide almost the same RRF values. It is, therefore, always not necessary to calculate the RRFs with both the methods. This study suggests that 99mTc-DMSA may be the primary choice for the evaluation of RRF, but if the glomerular filtration rate (GFR) and renogram curve are required, 99mTc-DTPA can be the obvious selection.

Usefulness of analytical parameters in the management of paediatric patients with suspicion of acute pyelonephritis. Is procalcitonin reliable? / Utilidad de los parámetros analíticos en el manejo de los pacientes pediátricos con sospecha de pielonefritis aguda. ¿Es fiable la procalcitonina?

OBJECTIVE: To investigate the usefulness of procalcitonin (PCT) and other analytical parameters (white blood cell count [WBC], C-reactive protein [CRP]) as markers of acute renal damage in children after a first febrile or afebrile urinary tract infection (UTI). METHODS: A retrospective study was conducted on children with a first episode of UTI admitted between January 2009 to December 2011, and in whom serum PCT, CRP and white blood cell count were measured, as well as assessing the acute renal damage with renal scintigraphy with 99mTc-DMSA (DMSA) within the first 72h after referral. A descriptive study was performed and ROC curves were plotted, with optimal cut-off points calculated for each parameter. RESULTS: The 101 enrolled patients were divided into two groups according to DMSA scintigraphy results, with 64 patients being classified with acute pyelonephritis (APN), and 37 with UTI. The mean WBC, CRP and PCT values were significantly higher in patients with APN with respect to normal acute DMSA. The area under the ROC curve was 0.862 for PCR, 0.774 for WBC, and 0.731 for PCT. The optimum statistical cut-off value for PCT was 0.285ng/ml (sensitivity 71.4% and specificity 75%). CONCLUSION: Although the mean levels of fever, WBC, CRP, and PCT were significantly increased in patients with APN than in those who had UTI, the sensitivity and specificity of these analytical parameters are unable to predict the existence of acute renal damage, making the contribution by renal DMSA scintigraphy essential.

Reappraisal of the effectiveness of 99mTc-dimercaptosuccinic acid scans for selective voiding cystourethrography in children with a first febrile urinary tract infection.

Recent studies have yielded conflicting results regarding the ability of technetium-99m dimercaptosuccinic acid ((99m)Tc-DMSA) renal scans for identifying high-grade vesicoureteral reflux (VUR) in children with a first febrile urinary tract infection (UTI). This study aimed to reevaluate the effectiveness of (99m)Tc-DMSA renal scans for selective voiding cystourethrography (VCUG) in children with a first febrile UTI. The medical records of children aged ≤ 5 years who were admitted with a first febrile UTI were retrospectively reviewed. Ultrasonography (US) and DMSA renal scans were performed within 3-5 days after admission, and VCUG was performed 7-10 days after antibiotics treatment. A total of 653 children were enrolled for analysis, including 579 patients aged < 2 years (Group A) and 74 patients aged 2-5 years (Group B). In Group A, DMSA scans were abnormal for 346 patients (59.8%), and normal for 233 patients (40.2%). High-grade VUR was present in 99 of 346 patients (28.9%) with abnormal DMSA scans, but present in only 16 of 233 patients (6.9%) with normal DMSA scans (p < 0.001). Regarding the prediction of high-grade VUR, the sensitivity and negative predictive value (NPV) for the DMSA scans were 86.1% and 93.1%, respectively. In Group B, DMSA scans were abnormal for 36 patients (48.6%), and normal for 38 patients (51.4%). High-grade VUR was present in 12 of 36 patients (33.3%) with abnormal DMSA scans, whereas none of the 38 patients with normal DMSA scans had high-grade VUR (p < 0.001). The sensitivity and NPV of the DMSA scans were both 100%. Using the selective VCUG strategy, approximately 40% of Group A patients and 50% of Group B patients could be spared an unnecessary VCUG, respectively. Our study results suggest that (99m)Tc-DMSA renal scans are effective in identifying children with a first febrile UTI for selective VCUG.

The Decision of Voiding Cystourethrography in Children with Urinary Tract Infection

PURPOSE: We attempted to compare the independent factors such as age, sex, C-reactive protein(CRP), and white blood cell count(WBC) in children with radiologic studies and assess the necessity of performing voiding cystourethrography(VCUG). METHOD: 98 children who have been diagnosed their first time febrile urinary tract infection from Janurary 2002 to Januray 2005 were enrolled. In all patient, the duration of fever which occurred before and after treatment was recorded, and CRP, WBC, (99m)Tc-2,3-dimercaptosuccinic acid((99m)Tc-DMSA) renal scans, renal ultrasound and VCUG were analyzed. RESULTS: Of the 98 children diagnosed with urinary tract infection(UTI), 52 were male and 46 were female. 18 had abnormalities in VCUG, 17 had abnormalities in kidney ultrasound, and 20 had partial defects or diffuse uptake decrease in (99m)Tc-DMSA renal scans. There were no significant relationship between incidence of radiologic abnormalities and age. The risk of renal scar was significantly higher in children who had a longer febrile period before treatment than in those with shorter period. Both CRP and WBC were significantly elevated in children with the radiological abnormalities. A positive of (99m)Tc-DMSA renal scans and renal ultrasound were highly associated with vesicoureteral reflux(VUR). CONCLUSION: If there are abnormalities in the kidney ultrasound and (99m)Tc-DMSA renal scan of a child with initial UTI, a VCUG is recommended. Even in cases without abnormal findings in (99m)Tc-DMSA renal scan and renal ultrasound, clinical data such as CRP and WBC should be assessed, and VCUG should be performed for the undetected VUR.

Usefulness of serum procalcitonin test for the diagnosis of upper urinary tract infection in children / 소아과

PURPOSE: It is difficult to make a distinction between lower urinary tract infection(UTI) and acute pyelonephritis(APN) during the acute phase of febrile UTI due to nonspecific clinical symptoms and laboratory findings, especially among young children. We measured the serum procalcitonin(PCT) in children with UTI to distinguish between acute pyelonephritis and lower UTI, and to determine the accuracy of PCT measurement compared with other inflammatory markers. METHODS: Serum samples were taken from children who admitted with unexplained fever or were suspected of having UTI. 51 children(mean 12.2+/-11.4 months) were enrolled in this study. Leukocyte counts, erythrocyte sedimentation rates(ESR) and C-reactive protein(CRP) were also measured. Renal parenchymal involvement was assessed by (99m)Tc DMSA scintigraphy in the first 7 days after admission. PCT was measured by immunoluminometric assay. RESULTS: PCT values were significantly correlated with the presence of renal defects in children with UTI(n=16)(5.06+/-12.97 microgram/L, P<0.05). However, PCT values were not significantly different between children with UTI without renal damage(n=18) and children without UTI(n=17). Using a cutoff of 0.5 microgram/L for PCT and 20 mm/hr for ESR, 20 mg/L for CRP, sensitivity and specificity in distinguishing between UTI with and without renal involvement were 81.3 percent and 88.9 percent for PCT 87.5 percent and 72.2 percent for ESR, and 87.5 percent and 55.6 percent for CRP, respectively. Positive and negative predictive values were 86.7 percent and 84.2 percent for PCT and 60.9 percent and 81.8 percent for CRP, respectively. CONCLUSION: In febrile UTI, PCT values were more specific than CRP, ESR and leukocyte count for the identification of patients who might develop renal defects.

Voiding cystourethrography in children with an initial episode of febrile urinary tract infection / 소아과

PURPOSE: Because voiding cystourethrography(VCUG) is an invasive method, we studied whether VCUG could be postponed through evaluation of alternative non-invasive tests including renal ultrasonography and (99m)Tc-DMSA renal scan. METHODS: We reviewed the medical records of 175 patients initially diagnosed with febrile urinary tract infection during the one year period of 1999, and compared 3-tests:renal ultrasongraphy, (99m)Tc-DMSA renal scan, and VCUG. RESULTS: Renal ultrasonography didn't contribute to the prognostication of pyelonephritis(photopenic areas) or vesicoureteral reflux(VUR). Presentation of photopenic areas in (99m)Tc-DMSA renal scan was related to VUR. If both findings of renal ultrasonography and (99m)Tc-DMSA renal scans were normal, this condition was closely related to normal results in VCUG. And if both examinations were abnormal, the condition was closely related to VUR. But this state could not always guarantee the normal result from VCUG because of low sensitivity in finding VUR. CONCLUSION: In cases in which acute phyelonephritis is demonstrated by (99m)Tc-DMSA renal scan, VCUG is required. In addition to this, if the conditions of hydronephrosis, vesicoureteral dilatation, increases of renal volume, and changes of echogenesity are shown by renal ultrasonography, VCUG should be performed. If a patient has difficulty undergoing VCUG, temporary postponement of VCUG can be taken into consideration, but only in cases where both examinations of renal ultrasonography and (99m)Tc-DMSA renal scan are normal. Nevertheless, close observation is be advised even in this case.

The Occurrence of Renal Scarring in Children with Unilateral Vesicoureteral Reflux / 소아과

PURPOSE: We evaluated the occurrence of renal scarring in children with unilateral vesicoureteral reflux (VUR), and the relationships between renal scar formation and risk factors such as VUR, duration of fever, acute-phase reactant, age, and sex. METHODS: We retrospectively analyzed the data of 35 children newly diagnosed with unilateral vesicoureteral reflux after urinary tract infection (UTI) in Wallace Memorial Baptist Hospital between January 1996 and December 2004. Ultrasonography, Erythrocyte sedimentation rate (ESR), and C- reactive protein (CRP) were performed initially. Voiding cystourethrography (VCUG) was performed 1 to 3 weeks after treatment with UTI. (99m) Tc-dimercaptosuccinic acid (DMSA) scan was performed 4 to 6 months after treatment. RESULTS: Scintigraphic renal damage was present in 29 percent of the refluxing and in 3 percent of the nonrefluxing kidneys (P< 0.05). The severity of VUR was significantly correlated with renal scar formation (P< 0.05). The duration of fever before treatmen (5.0+/-1.3 vs 2.6+/-1.3) and prolonged fever of over 5 days were significantly different between renal scar group and non-renal scar group (P< 0.05). ESR (56.3+/-23.8 vs 27.9+/-18.1 mm/hr, P< 0.05) and CRP (12.8+/-7.3 vs 3.9+/-3.8 mg/dL, P< 0.05) at the diagnosis of UTI in the renal scar group were higher, compared to those of the non-renal scar group. There were no significant differences in age and sex between the two groups. CONCLUSION: The presence and grade of VUR, the duration of fever before treatment, prolonged fever over 5 days, ESR, and CRP were risk factors for renal scarring, irrespective of age and sex. Diagnosis and management of VUR, in children with UTI, is important to prevent renal scars.

A Case of Acute Poststreptococcal Glomerulonephritis Accompanied with Acute Pyelonephritis

Acute poststreptococcal glomerulonephritis(APSGN) is the most common form of postinfectious glomerulonephritis, and acute pyelonephritis(APN) is the most severe form of urinary tract infection in childhood. However, the concurrence of two diseases is uncommon in the literature. We describe a case of APSGN accompanied with APN in a 5-year-old female who presented with fever, left flank pain, headache and facial edema. Urinalysis showed pyuria, microscopic hematuria, and mild proteinuira. Serial urine cultures grew Escherichia coli. (99m)Tc-DMSA renal scan revealed a cortical defect in the upper pole of left kidney. She had a history of preceding pharyngitis, in addition, showed high blood pressure, high anti-streptolysin O titer, and low serum complement levels. The patient improved completely with supportive treatment, including antibiotic and antihypertensive therapy. These findings suggested that APSGN and APN could be manifested simultaneously or be superimposed on each other.

The Correlation between Relative Renal Uptake of (99m)Tc-DMSA Renal Scan and Glomerular Filtration Rate in Patients with Reduced Renal Function / 대한신장학회잡지

BACKGROUND: Glomerular filtration rate(GFR) is an important parameter for the evaluation and monitoring of renal function. The aim of this study was to investigate the correlation between the relative 1 hour uptake of (99m)Tc-DMSA renal scan(DMSA- %uptake, TRUR) and GFR which was estimated by (99m)Tc-DTPA, serum creatinine and 24 hour-urinary creatinine excretion. METHODS: Between January 1998 and March 2001, 65 patients had undergone (99m)Tc-DMSA renal scan, (99m)Tc-DTPA renal scan, serum creatinine and 24 hour-urinary creatinine excretion. Of them, 42 patients had moderately or severely reduced renal function(DTPA-GFR 0.05). In group B, TRUR (mean+/-S.D. 16.3+/-7.4%) was significantly correlated with DTPA-GFR(r=0.731, p < 0.01). In both group, serum creatinine, Ccr and C and G Ccr were significantly correlated with TRUR. CONCLUSION: Although the relative 1 hour uptake of the (99m)Tc-DMSA renal scan, as a method of renal cortical image could not estimate the true GFR, it showed a good correlation with GFR in patients with moderately reduced renal function. (99m)Tc-DMSA renal scan seems to be helpful to evaluate the renal function in patients with moderately reduced renal function.

Diagnostic Value of (99m)Tc-DMSA Pinhole Imaging in Childhood Urinary Tract Infection with Renal Cortical Defect

PURPOSE: The aim of this study was to assess the diagnostic value of the (99m)Tc-DMSA pinhole imaging by comparing the detection rate of cortical defects identified from planar and pinhole imaging. METHODS: (99m)Tc-DMSA planar and pinhole imaging, voiding cystoureth-rogram(VCUG), renal ultrasonography were performed in 67 patients diagnosed with urinary tract infection at the Department of Pediatrics, Sung-Ae General Hospital, from September, 1999 to Feburary, 2001. The follow-up of (99m)Tc-DMSA pinhole imaging was performed on 25 patients. RESULTS: Overall detection rate of (99m)Tc-DMSA planar imaging was 41.8%(28 patients/67 patients), but (99m)Tc-DMSA pinhole imaging showed cortical defects in 62.7%(42 patients/67 patients) and the patients with renal cortical defects in planar imaging showed all definite or more additional cortical defects in pinhole imaging. The detection rate of cortical defect by (99m)Tc- DMSA pinhole imaging in patients with vesicoureteral reflux(VUR) was 80%(24 kidneys/30 kidneys). Those without VUR, however, also presented high detection rate as 25.9%(27 kidneys/ 104 kidneys). Out of 25 patients, improvement of cortical defect was presented in 19, no change in 4, and aggravation in 2 from the follow-up studies by (99m)Tc-DMSA pinhole imaging. CONCLUSION: This study indicates that (99m)Tc-DMSA pinhole imaging is superior to planar imaging and, hence, that pinhole imaging is a useful initial diagnostic tool for children suspected of urinary tract infection, irrespective of VUR, and to identify patients who need more extensive radiological studies and early treatment.

Obstruction of the Ureteropelvic Junction in Children: Functional Evaluation of the Obstructed Kidney Postoperatively Using the 99mTc-DMSA Renal Scan / 대한비뇨기과학회지

Ten children were selected out of 21 cases diagnosed as ureteropelvic junction obstruction between March, 1989 and March, 1992. The children were evaluated quantitatively using the renal cortical labeling agent, 99m technetium dimercaptosuccinic acid (Tc-DMSA), before and following pyeloplasty. The preoperative residual renal function and the extent of functional recovery were investigated. The children ranged from 15 months to 13 years old (average 6.8 years) and consisted of 8 boys and 2 girls. The obstruction was on the left in 7 cases and the right in 3. Symptoms on admission included pain in 5 cases, abdominal mass in 3 cases, and fever and chill in 2. The subjects divided into two groups. The first group consisted of children who did not have complications or other coexisting diseases, while the second consisted of who had pyonephrosis or vesicoureteral reflux. All patients underwent dismembered pyeloplasty and the results were satisfactory in all. 1. The preoperative differential renal function by Tc-DMSA renal scintigraphy ranged from 0.5% to 46.0% (mean 19.1%) and increased to 3.5% to 46.9% (mean 28.8%) postoperatively. 2. In five of the seven cases with uncomplicated ureteropelvic junction obstruction, differential renal function increased more than 1096 following pyeloplasty. In the two other cases which showed preserved renal function of up to 4096 preoperatively, noticeable changes not observed. 3. In the three cases with complicated ureteropelvic junction obstruction, (two cases associated with pyonephrosis and one case with vesicoureteral reflux) only slight increased differential renal function. In conclusion, we suggest that severely obstructed kidneys in infants and children spare nephrectomy and encourage pyeloplasty, even in cases of non-visualization on excretory urography in hopes of improving relative renal function.

Quantitative Analysis of Absolute Renal Uptake of 99m-Tc-DMSA in Normal Adults / 대한비뇨기과학회지

Renal function has been evaluated by 99m-Tc-DMSA scanning through the amount of radioactivities uptaken by the right and left kidneys. But, since the analysis on relative renal functions can't solve the quantitative standard of absolute renal functions, it is difficult to diagnose or follow up on renal diseases. For example, it becomes very hard to understand the functional compensation of a healthy kidney in case there are diseases in a single kidney or in one side of the kidney. Thus, this study was performed in order to quantify the absolute renal uptake rate and to find out the contributing factors in 99m-Tc-DMSA scanning on healthy adults. The subjects of this study were based on the tests which were taken before the operations of 54 donors of kidney transplantation(male :40 female :14) from 1989. 6. to 1994. 4. The test results showed that there was no significant difference between the right and left kidneys-right renal uptake level being 18.29+/-6.22% and, left 18.37+/-6.23%. It also showed that as people get older the renal uptake rate gradually decreases-the uptake level of 20's :2l.80+/-7.87%, 30's : 17.29+/-4.78%, 40's : 17.28+/-3.71%, 50's : 16.06+/-3.79%, 60's : 13.27+/-2.17%. But there was no differences between male and female (p>0.5). Higher 99m-Tc-DMSA renal uptake rate was shown the farther the kidneys were located from the skin (p0.5). Thus, though results may vary according to what scanning machines used and their revised levels, by quantifying the absolute renal uptake rate on healthy kidneys, 99m-Tc-DMSA scanning serves as an indirect index in estimating the degrees of renal diseases.