succimer and Dilatation--Pathologic

Dilating vesicoureteral reflux provokes concern for physicians and parents that often leads to corrective surgery in young children. Since there are limited data describing the natural history of dilating vesicoureteral reflux in infants, we identified factors predictive of resolution/improvement in infants initially treated nonoperatively.. We reviewed the medical records of 90 infants 6 months old or younger from 2004 to 2010 who were referred for prenatal hydronephrosis or initial febrile urinary tract infection and found to have dilating vesicoureteral reflux (grade 3 or greater). Variables of interest included presentation, dimercapto-succinic acid results, sex, breakthrough febrile urinary tract infections, reflux grade and bilateral reflux. Cox regression analysis was performed to determine predictors of spontaneous resolution and/or improvement to reflux grade less than 3 as well as predictors of surgical intervention.. Included in final analysis were 80 infants (113 renal units). Of the patients 51 (64%) experienced spontaneous resolution/improvement with a mean followup of 29 months before resolution, discharge home and/or end of followup. Only 20 patients (25%) underwent surgery. Cox regression analysis revealed that a normal initial dimercapto-succinic acid scan, initial reflux grade less than 5 and absent breakthrough febrile urinary tract infections were predictive of reflux resolution/improvement (p <0.05). Dimercapto-succinic acid scan abnormalities, prenatal hydronephrosis and breakthrough febrile urinary tract infections were significant predictors of surgery (p <0.05).. Dilating vesicoureteral reflux in infancy often resolves/improves spontaneously. Therefore, surgery should be directed toward patients unlikely to experience resolution, ie those with an abnormal initial dimercapto-succinic acid scan, grade 5 vesicoureteral reflux and breakthrough febrile urinary tract infections.

Topics: Dilatation, Pathologic; Female; Humans; Male; Nomograms; Proportional Hazards Models; Radiopharmaceuticals; Remission, Spontaneous; Retrospective Studies; Succimer; Vesico-Ureteral Reflux

We describe a case of congenital segmental giant megaureter in a boy that presented as a fetal abdominal mass. He also had bilateral undescended testes, bilateral vesicoureteral reflux, and segmental aniridia. He presented with hypoglycemia in the neonatal period that resolved. Postnatal magnetic resonance imaging, voiding cystourethrography and radionuclide imaging established the diagnosis, and a ureteroureterostomy was performed at 12 months.

Topics: Abnormalities, Multiple; Aniridia; Cryptorchidism; Diagnosis, Differential; Dilatation, Pathologic; Female; Fetus; Functional Laterality; Humans; Infant, Newborn; Magnetic Resonance Imaging; Male; Pregnancy; Prenatal Diagnosis; Preoperative Care; Radiography; Radioisotope Renography; Succimer; Treatment Outcome; Ultrasonography; Ultrasonography, Prenatal; Ureter; Vesico-Ureteral Reflux

We compared the estimation of differential renal function by 99mtechnetium (Tc)-dimercapto-succinic acid (DMSA) and 99mTc-pentetic acid scintigraphic methods for followup of prenatally diagnosed unilateral renal pelvic dilatation.. We retrospectively analyzed differential renal function estimations calculated by static and dynamic methods in time matched test pairs that were included in the charts of 51 children monitored for prenatally diagnosed unilateral renal pelvic dilatation at our institution in a 5-year period.. There were 96 test pairs with available archived raw data. Using the analytic method of assessment of agreement between the 2 tests, a 95% limit of agreement of +/-9% was calculated. Of the 96 pairs of tests the results of 94 revealed no significant difference. Subgroup analysis by patient age and operative intervention (13 postoperative pairs) also showed no difference in the results of the 2 tests.. We established the 95% limits of agreement between 99mTc-DMSA and 99mTc-pentetic acid tests of differential renal function to be +/-9% discrepancy in 96 test pairs. During followup of prenatally diagnosed unilateral renal pelvic dilatation the assessment of differential renal function can be made by 99mTc-DMSA static or dynamic diuretic renography techniques. This interchangeability is consistent at all patient ages regardless of operative intervention. Since dynamic diuretic renography provides differential function and drainage data, using 99mTc-DMSA in this context is unnecessary and subjects patients to an unnecessary radiation burden.

Topics: Dilatation, Pathologic; Female; Humans; Infant; Kidney Diseases; Kidney Pelvis; Organotechnetium Compounds; Pregnancy; Prospective Studies; Radioisotope Renography; Reproducibility of Results; Retrospective Studies; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pentetate; Ultrasonography, Prenatal

Failure of a kidney to grow satisfactorily in childhood is evidence of renal disease. Because kidneys may enlarge during an episode of acute pyelonephritis, concomitant renal length measurements cannot be used as baselines for growth assessment. This study was designed to determine the degree of renal enlargement in children with acute pyelonephritis and the time the enlargement takes to resolve after treatment is started to find the optimum time for obtaining baseline measurements.. In a cohort study, 180 children younger than 5 years old with their first proven acute urinary tract infection, with or without pyelonephritis, had renal scintigraphy and sonography within 15 days of starting treatment. The presence of cortical defects on scintigrams indicated pyelonephritis. The lengths of kidneys with and without scintigraphic defects (i.e., with and without pyelonephritis) were compared, adjusting for age and sex, and the length of kidneys with defects was related to time elapsed between the start of treatment and sonography.. Ninety-nine kidneys (28%) in 77 children (43%) had scintigraphic defects. Kidneys with defects were an average of 3.2 mm longer than kidneys without defects. Length and time interval between treatment and sonography in kidneys with defects correlated negatively, with mean length approaching that of kidneys without defects by 10-11 days.. Kidneys with acute pyelonephritis initially increase in length but return to normal on average by the 11th day of treatment. If poor renal growth is used as an indication of renal disease, sonography should be delayed or repeated at least 2 weeks after the start of treatment to determine the length of the uninflamed kidney.

Topics: Acute Disease; Analysis of Variance; Child, Preschool; Cohort Studies; Dilatation, Pathologic; Female; Gluconates; Humans; Infant; Kidney; Male; Organotechnetium Compounds; Prospective Studies; Pyelonephritis; Radionuclide Imaging; Regression Analysis; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Time Factors; Ultrasonography