Author:

Keywords:

Adolescent, Adult, Algorithms, Child, Child, Preschool, Female, Follow-Up Studies, Humans, Infant, Kidney, Kidney Function Tests, Male, Radiopharmaceuticals, Retrospective Studies, Technetium Tc 99m Dimercaptosuccinic Acid, Urinary Tract Infections, Urodynamics, Vesico-Ureteral Reflux, Science & Technology, Life Sciences & Biomedicine, Radiology, Nuclear Medicine & Medical Imaging, vesicoureteral reflux, reflux nephropathy, renal scintigraphy Tc-99(m)-DMSA, paedriatric urology, URINARY-TRACT INFECTION, DIMERCAPTOSUCCINIC ACID, RENAL SCINTIGRAPHY, CHILDREN, TECHNETIUM-99M-DMSA, PEDIATRICS, KIDNEYS, Radionuclide Imaging, 1103 Clinical Sciences, Nuclear Medicine & Medical Imaging, 3202 Clinical sciences

Abstract:

AIM: To evaluate kidney function before and after surgical correction of vesicoureteral reflux. The long-term effect was measured with quantitative nephro-scintigraphy using 99Tcm labelled dimercaptosuccinic acid (99Tcm-DMSA). METHODS: Forty-five children with a history of urinary tract infections due to vesicoureteral reflux (VUR) were studied. VUR grade was determined with contrast voiding cystourethrography. Planar scintigraphy was performed with 99Tcm-DMSA and uptake measured as a percentage of injected dose. Kidney function was evaluated at baseline and 5 years after corrective surgery. RESULTS: Three months after surgery, persistent mild reflux was found in eight of 76 treated renal units. Kidney uptake at 5-year follow-up was unchanged in the majority of children, indicating preservation of renal function found at baseline. The split renal function showed an excellent correlation (r = 0.99) between baseline and follow-up studies (regression slope 1.01). Percentage uptake had a regression slope of 0.89 significantly different from unity (P<0.05). Empirical kidney-depth correction techniques were compared. The scintigraphic pattern worsened in six kidneys, indicative of increased scarring in a minority of children. CONCLUSION: Planar nephro-scintigraphy with 99Tcm-DMSA was well tolerated in our paediatric population, and appeared appropriate to evaluate kidney function in time. After surgical correction of VUR, the baseline function was maintained in 94% of kidneys.