succimer and Hydronephrosis

Topics: Algorithms; Animals; Female; Follow-Up Studies; Humans; Hydronephrosis; Infant, Newborn; Male; Pyelonephritis; Succimer; Tomography, Emission-Computed, Single-Photon; Ultrasonography; Ureteral Obstruction

Over the past 10 years new imaging and interventional techniques have drastically changed the ease and scope of urologic diagnosis and treatment. It is both rewarding and exciting to approach each clinical problem with a broad armamentarium of available studies, always seeking the most efficient and direct route to diagnosis. Similarly, radiologic interventional techniques are potentially applicable to a multitude of problems and should be innovatively considered in the urologic patient including patients in the pediatric age group.

Topics: Abscess; Child; Child, Preschool; Female; Humans; Hydronephrosis; Ileum; Infant; Iodohippuric Acid; Kidney; Kidney Diseases; Male; Pentetic Acid; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Succimer; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pentetate; Tomography, X-Ray Computed; Ultrasonography; Ureteral Obstruction; Urethra; Urinary Bladder; Urinary Calculi; Urinary Diversion; Urologic Diseases; Vesico-Ureteral Reflux

We previously reported contradictory supranormal nuclear renographic differential renal function in cases of unilateral hydroureteronephrosis, in which the kidneys with hydroureteronephrosis paradoxically had a greater differential function than the contralateral normal mate, based on diethylenetriaminepentaacetic acid (DTPA) nuclear renography. To evaluate whether DTPA supranormal differential function represented true hyperfunction, patients with DTPA supranormal differential function were evaluated with dimercaptosuccinic acid (DMSA) nuclear renography and the results were compared. A total of 16 patients with unilateral hydronephrosis was identified to have DTPA differential function of 53% or more. They were younger than age 1 year and had never undergone any urological surgery. In all 16 patients the DMSA differential function (mean 51.1%, range 42 to 57%) was lower than their own corresponding DTPA differential function (mean 58.3%, range 53 to 66%, p < 0.0001). In addition, the DMSA differential function was not significantly different from the intuitively anticipated mean of 50% (p = 0.48). The DTPA supranormal differential function identified in our patients was not corroborated by the DMSA differential function. With recent evidence that DMSA differential function may be a better predictor of outcome following relief of unilateral ureteral obstruction consideration should be given to using DMSA as a potentially more relevant method for differential function measurement in the setting of unilateral hydronephrosis. Conversely, until the potential deficiencies of DTPA are fully understood caution should be exercised in the interpretation of DTPA differential function in the setting of hydronephrosis.

Topics: Artifacts; Humans; Hydronephrosis; Infant; Infant, Newborn; Pentetic Acid; Radioisotope Renography; Succimer

Hydronephrosis, a condition that is mostly congenital, is considered as the most common type of pediatric urinary tract disorder. The aim of this study was the evaluation of the prognosis and outcomes of hydronephrosis in cases of congenital hydronephrosis.. In a cross-sectional study, run in a tertiary clinic of pediatric nephrology, from 2015 to 2020, patients with fetal hydronephrosis were selected. Ultrasonography, urinalysis and kidney function tests were ordered for all patients and in the presence of hydronephrosis, repeated ultrasonography, voiding cystourethrography and dimercaptosuccinic acid scan were performed. In cases with evidence of obstruction, a diethylenetriamine pentaacetic acid scan and relative surgical procedures were performed.. Among 141 cases, mean age was 8 ± 1.4 years and 80.9% were male. Partial or complete obstruction in the right and left kidney was found in 16.3 and 24.8% of patients, respectively. The degree of hydronephrosis was mild in 46.1%, moderate in 39%, and severe in 9.2% of the patients. At the last follow-up period, hydronephrosis recovered in 46% of the patients, while 54% experienced persistence or exacerbation of the disease. Meanwhile, 7.1% of patients showed neurogenic bladder, 19.1% urinary tract infection and 22.7% urinary stones.. Our study revealed that fetal hydronephrosis ends in complete recovery following birth in 46% of the cases. However, in cases experiencing persistent or exacerbating hydronephrosis, optimized treatment and/or surgical intervention are required.  DOI: 10.52547/ijkd.6516.

Topics: Child; Cross-Sectional Studies; Female; Humans; Hydronephrosis; Male; Pentetic Acid; Pregnancy; Succimer; Ultrasonography, Prenatal; Urinary Tract Infections

Children with unilateral hydronephrosis are followed up with anteroposterior pelvic diameter (APD), hydronephrosis grade, mercaptoacetyltriglycine (MAG-3) drainage pattern and differential renal function (DRF). Indeterminate drainage preserved DRF in higher grades of hydronephrosis, in some situations, complicating the decision-making process. Due to an asymmetric renal area ratio, falsely negative DRF estimations can result in missed optimal surgery times. This study was designed to assess whether correcting the DRF estimation according to kidney area could reflect the clinical situation of a hydronephrotic kidney better than a classical DRF calculation, concurrently with the hydronephrosis grade, APD and MAG-3 drainage pattern.. We reviewed the MAG-3, dimercaptosuccinic acid (DMSA) scans and ultrasonography (US) of 23 children (6 girls, 17 boys, mean age: 29 ± 50 months) with unilateral hydronephrosis. MAG-3 and DMSA scans were performed within 3 months (mean 25.4 ± 30.7 days). The closest US findings (mean 41.5 ± 28.2 days) were used. DMSA DRF estimations were obtained using the geometric mean method. Secondary calculations were performed to correct the counts (the total counts divided by the number of pixels in ROI) according to kidney area. The renogram patterns of patients were evaluated and separated into subgroups. The visual assessment of DMSA scans was noted and the hydronephrotic kidney was classified in comparison to the normal contralateral kidney's uptake. The correlations of the DRF values of classical and area-corrected methods with MAG-3 renogram patterns, the visual classification of DMSA scan, the hydronephrosis grade and the APD were assessed.. DRF estimations of two methods were statistically different (p: 0.001). The categories of 12 hydronephrotic kidneys were changed. There were no correlations between classical DRF estimations and the hydronephrosis grade, APD, visual classification of the DMSA scan and uptake evaluation. The DRF distributions according to MAG-3 drainage patterns were not different. Area-corrected DRF estimations correlated with all: with an increasing hydronephrosis grade and APD, DRF estimations decreased and MAG-3 drainage patterns worsened. A decrease in DRF (< 45 %) was determined when APD was ≥ 10 mm. When APD was ≥ 26 mm, a reduction of DRF below 40 % was determined.. Our results suggest that correcting DRF estimation for asymmetric renal area ratio in unilateral hydronephrosis can be more robust than the classical method, especially for higher grades of hydronephrotic kidneys, under equivocal circumstances.

Topics: Adolescent; Child, Preschool; Female; Humans; Hydronephrosis; Infant; Kidney; Kidney Function Tests; Male; Retrospective Studies; Succimer; Ultrasonography

We report a 7-year-old child with Laurence-Moon-Biedl syndrome, an autosomal recessive syndrome, with impaired renal function detected by means of technetium-99m diethylenetriamine-pentaacetic acid (Tc-99m DTPA), technetium-99m dimercaptosuccinic acid (Tc-99m DMSA) scintigraphy, and ultrasonography. The altered renal morphology and decreased renal functions are documented.

Topics: Child; Female; Humans; Hydronephrosis; Kidney; Laurence-Moon Syndrome; Organotechnetium Compounds; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pentetate

The accumulation of radioactivity in the dilated collecting system potentially influences the calculation of differential renal function on the radionuclide test. We focused on this reservoir effect in unilateral hydronephrosis and assessed the reliability of calculating differential renal function by dimercapto-succinic acid (DMSA) uptake 2 hours after injection.. Unilateral partial ureteral obstruction was created in 8-week-old rats. Four weeks after surgery the animals were sacrificed 2 and 24 hours after the injection of tracer. The DMSA uptake rates of the renal parenchyma and collecting system were measured separately by autowell gamma counter. Differential function was calculated according to renal parenchymal and whole kidney (parenchyma and collecting system) uptake.. There was a higher accumulation of DMSA in the dilated renal pelvis at 2 than at 24 hours. However, DMSA uptake in the collecting system was extremely small in comparison to that in the parenchyma. As a result; differential renal function calculated using parenchymal uptake was similar to that calculated using whole kidney uptake measured 2 and 24 hours after injection.. Our data suggest that the pure reservoir effect of DMSA uptake at early measurement is much smaller than reported in previous experimental animal studies. Further clinical studies are needed to reexamine this reservoir effect in children with unilateral hydronephrosis.

Topics: Animals; Hydronephrosis; Injections; Organotechnetium Compounds; Rats; Rats, Sprague-Dawley; Reproducibility of Results; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Time Factors; Ureteral Obstruction

To examine the characteristics of primary vesico-ureteric reflux (VUR) in young infants following prenatal hydronephrosis.. The study comprised 155 consecutive infants with VUR detected at a mean age of 8.7 weeks (SD 6.3). Reflux units (n = 236) were analysed for relationships between gender, severity of reflux, exposure to urinary tract infection (UTI) and the presence of focal and generalized types of kidney damage on imaging. Bladder wall thickness (from ultrasonography) was examined in comparison with a further group of 29 males without VUR.. Male infants predominated (117 of 155, 75%); bilateral VUR affected the same proportion (52%) of males and females. Most kidneys exposed to VUR (158 of 236. 67%) were normal and of the 78 abnormal kidneys (57 without UTI), 53 showed generalized damage (only eight exposed to UTI) and 71 (91%) were associated with severe (grades IV and V) reflux that predominantly affected males (P < 0.001). Grade V reflux was almost exclusively a male disorder. Most female units (45 of 58, 78%) compared with 46% (82/178) of male units had mild (grades I to III) reflux that was independently associated with normal kidneys. The mean bladder wall thickness was significantly greater for males with VUR than for females with VUR and for males without VUR.. Two distinct but not exclusive patterns of VUR were identified: (i) mild reflux associated with normal kidneys that affected most females and a proportion of males; (ii) severe reflux combined with kidney damage, most likely fetal in origin, that is almost exclusively a male disorder.

Topics: Female; Fetal Diseases; Follow-Up Studies; Gestational Age; Humans; Hydronephrosis; Infant; Kidney; Male; Prenatal Diagnosis; Prospective Studies; Radioisotope Renography; Sex Factors; Succimer; Urinary Bladder Diseases; Vesico-Ureteral Reflux

Topics: Female; Humans; Hydronephrosis; Infant, Newborn; Kidney; Male; Organotechnetium Compounds; Pregnancy; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Ultrasonography, Prenatal; Vesico-Ureteral Reflux

Topics: 3-Iodobenzylguanidine; Adrenal Gland Neoplasms; Diagnosis, Differential; False Positive Reactions; Female; Humans; Hydronephrosis; Iodine Radioisotopes; Iodobenzenes; Middle Aged; Organotechnetium Compounds; Pheochromocytoma; Radionuclide Imaging; Radiopharmaceuticals; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Medronate; Technetium Tc 99m Pentetate; Tomography, X-Ray Computed; Urography

To determine the frequency of fetal urinary tract anomalies and to characterize the types of such abnormalities detected on ultrasonography and the outcome of affected patients during a 15-year period at our institution.. We retrospectively reviewed the findings on maternal prenatal ultrasound examinations and the postnatal medical records of 56 children with urinary tract abnormalities detected by prenatal ultrasound examination at Mayo Clinic Rochester from November 1979 to June 1994.. Of the 56 children, 18 (32%) had severe urinary tract anomalies in conjunction with oligohydramnios, pulmonary hypoplasia, and perinatal death (Potter's syndrome). The other 38 infants had various urinary tract abnormalities--most commonly, isolated hydronephrosis and multicystic dysplasia of the kidney. Six of the 38 children had more than one renal abnormality detected prenatally. Reflux was noted in association with prenatally detected urinary tract abnormalities in 4 of 32 newborns (12%) who underwent voiding cystourethrography. In fetuses with normal amniotic fluid volume, the perinatal outcome was good. Children with lower urinary tract obstruction had evidence of more severe renal dysfunction than did those with involvement at more proximal levels. The presence or absence of urinary tract obstruction postnatally could not be determined reliably on the basis of prenatal ultrasound appearance.. In this study, more than half of all prenatally detected urinary tract abnormalities were isolated hydronephrosis or multicystic dysplasia of the kidney. Postnatal renal function could not be reliably predicted on the basis of prenatal ultrasound findings.

Topics: Female; Follow-Up Studies; Humans; Hydronephrosis; Infant; Infant, Newborn; Kidney Function Tests; Lung; Male; Oligohydramnios; Organotechnetium Compounds; Polycystic Kidney Diseases; Pregnancy; Pregnancy Outcome; Radionuclide Imaging; Retrospective Studies; Severity of Illness Index; Succimer; Syndrome; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Mertiatide; Technetium Tc 99m Pentetate; Ultrasonography, Prenatal; Ureterocele; Urinary Bladder Neck Obstruction; Urinary Tract

Scintigraphy with Tc-99m MAG3 is, to date, the most commonly used technique for evaluating separate renal function (SRF). In this study, the performance of this technique is compared to Tc-99m DMSA. A total of 37 patients with various kidney disorders (12 children and 25 adults) underwent both Tc-99m DMSA and Tc-99m MAG 3 scintigraphy. In children and adults of normal weight the correlation coefficient between the two methods was 0.99 (P < 0.001), whereas in individuals who were more than 10% overweight according to Broca, or who had abnormal anatomical positions of the kidneys, the correlation coefficient was 0.82 (P < 0.05). Scintigraphy with Tc-99m DMSA was more accurate in renal parenchyma lesions. These results indicate that Tc-99m DMSA scintigraphy is preferable for the evaluation of SRF in patients who are more than 10% overweight, or have abnormal positions of the kidneys.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Contraindications; Humans; Hydronephrosis; Infant; Kidney; Kidney Diseases; Kidney Neoplasms; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Mertiatide

The relationship between the period for recovery from hydronephrosis and the characteristics of the obstruction still needs to be clarified. In rat kidney the left ureter was completely obstructed for 3, 7, 14 and 21 d and the renal function was measured by renal scintigraphy using 99mTC-dimercaptosuccinic acid 3, 7 and 14 d after the obstruction was removed. In addition, recovery from unilateral partial obstruction (PO) of different degrees of severity for 7 d was examined. The kidneys with very mild PO recovered within 3 d and those with a very long period of complete obstruction (CO) did not exhibit any significant recovery. However, most of the kidneys with CO of various durations and those with 7 days PO of various degrees of severity exhibited maximum recovery 7 d after the release of the obstruction. This study suggests that the period required for maximum recovery from hydronephrosis is usually constant, unless the obstruction is too mild to cause any damage or too long to permit any recovery.

Topics: Animals; Hydronephrosis; Kidney; Male; Organotechnetium Compounds; Radionuclide Imaging; Rats; Rats, Wistar; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Time Factors; Ureter; Urethral Obstruction

To determine if a pre-operative non-invasive radionuclide study can predict the results of surgery in infants with pre-natally diagnosed hydronephrosis.. Eight male infants with prenatally diagnosed hydronephrosis were treated by pyeloplasty within the first 4 months of life. All infants underwent a pre-operative diuresis renogram and a dimercapto-succinic acid (DMSA) scan, followed by a further renogram 6 months after surgery to assess renal function and drainage.. There was a significant difference between the results of the relative renal function estimates obtained by the pre-operative renogram and the pre-operative DMSA scan (P = 0.001). In all patients the recovery in renal function following surgery was accurately predicted by the pre-operative DMSA scan.. The results of this preliminary study suggest that a pre-operative DMSA scan could replace the use of invasive nephrostomy drainage to assess the potential for recovery in the poorly functioning neonatal kidney and give an indication of those kidneys most likely to benefit from reconstructive surgery.

Topics: Humans; Hydronephrosis; Infant; Infant, Newborn; Kidney; Male; Postoperative Period; Prenatal Diagnosis; Preoperative Care; Radionuclide Imaging; Succimer

The effects of partial or total removal of the kidney with ectopic ureter on the contralateral kidney were evaluated using DMSA renal uptake rate on 8 patients. After partial nephrectomy on 6 cases, the affected residual kidneys showed significant decrease in DMSA renal uptake rate in 2 cases in which the extirpated kidneys had normal renal tissue in part but did not show significant change in DMSA uptake rate in 4 cases in which the extirpated kidneys were dominated mainly with dysplasia. Post-operative increase in DMSA uptake rate of the contralateral kidneys were significant in 3 of 4 patients who had the operation before they became 2 years old. In 2 of these 3 cases, pre-operative scintigram showed extremely low rate of DMSA renal uptake. Four cases aged 2 years old and over did not show post-operative increase in the uptake rate. As we have previously reported on the cases with hydronephrosis, these results suggest that 1) existence of obstruction caused by ectopic ureter inhibit the development of the contralateral kidney and 2) the growth of the kidney can resume the release of that obstruction, if the release is made while the kidneys are still in developing stage.

Topics: Child; Child, Preschool; Female; Humans; Hydronephrosis; Infant; Kidney; Kidney Function Tests; Nephrectomy; Postoperative Period; Succimer; Ureter

In 29 children with unilateral hydronephrosis who underwent surgery at the age from 2 months to 15 years (27 patients with ureteropelvic junction stenosis and 2 with obstructive megaureter), beta 2-microglobulin (beta 2-MG), alpha 1-microglobulin (alpha 1-MG), N-acetyl-beta-D-glucosaminidase (NAG) and albumin were determined in renal pelvic urine from the hydronephrotic kidney to evaluate renal dysfunction accompanying urinary tract obstruction. Moreover, it was also examined whether it is possible to predict functional recovery of the hydronephrotic kidney on the basis of relation between these indices and pre- and postoperative changes in renal dimercaptosuccinic acid (DMSA) uptake rate. The values of beta 2-MG, alpha 1-MG, NAG and albumin in urine from the renal pelvis were high in 48%, 50%, 75% and 83% of the patients, respectively. Among the patients of one year and up, those with low preoperative DMSA uptake rate tended to have high values of beta 2-MG, alpha 1-MG and NAG. On the contrary, albumin level was high in 78% of patients who had good preoperative DMSA uptake rate. With respect to the relation between pre- and postoperative changes in DMSA uptake rate and each index, beta 2-MG and alpha 1-MG were high in 73% and 62% of patients who exhibited a marked increase in postoperative DMSA uptake rate. In patients without a remarkable change in DMSA uptake rate before and after surgery, on the other hand, the values of these were high only in 25% and 36%.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acetylglucosaminidase; Adolescent; Age Factors; Albuminuria; Alpha-Globulins; beta 2-Microglobulin; Child; Child, Preschool; Female; Humans; Hydronephrosis; Infant; Kidney; Kidney Function Tests; Kidney Glomerulus; Kidney Pelvis; Kidney Tubules; Male; Succimer

Kidney involvement is one of the most frequent causes of death in progressive systemic scleroderma (PSS). It is therefore important to detect potential impairment of renal function in PSS very early. In 76 patients referred for nuclear medicine diagnostic procedures, 42 pathologic results were found with 131I-hippurate clearance, while only 14 abnormal results were detected by static 99mTc-DMSA scans. Hippurate clearance is thus a sensitive method of functional renal evaluation in PSS.

Topics: Adolescent; Adult; Female; Glomerular Filtration Rate; Humans; Hydronephrosis; Iodohippuric Acid; Kidney Diseases; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Scleroderma, Systemic; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid

Pre- and post-operative changes of renal function in twenty children (10 were younger than 2 years old) with unilateral hydronephrosis due to ureteropelvic junction obstruction were studied on the basis of DMSA renal uptake rate. A marked increase in DMSA renal uptake rate was observed in thirteen cases (65%) after pyeloplasty on the obstructed side. Among them eight children were younger than 2 years old. In 6 children younger than 2 years old, a remarkable increase of DMSA renal uptake rate after reconstructive operation was recognized not only on the obstructed side but also on the contralateral normal side. These tendency could not be observed in those older than 2 years old. These results suggest that, in the young children, the obstructed kidney inhibits the contralateral normal and compensatory renal growth, and that the relief of obstruction eliminates this inhibition and causes the renal growth spur in a normal kidney. We conclude that it is essential to correct unilateral ureteropelvic junction obstruction before two years of age if an improvement of renal function not only on the obstructed side but also on the normal side is to be expected.

Topics: Adolescent; Age Factors; Child; Child, Preschool; Constriction, Pathologic; Female; Humans; Hydronephrosis; Infant; Infant, Newborn; Kidney; Kidney Pelvis; Male; Organotechnetium Compounds; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid

Topics: Adolescent; Female; Humans; Hydronephrosis; Kidney; Kidney Calices; Kidney Pelvis; Organometallic Compounds; Pentetic Acid; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pentetate; Urethral Obstruction

During a 1.5 year period 21 children were investigated with 99-m-technetium dimercaptosuccinic acid (DMSA) before operation for hydronephrosis due to pelviureteric obstruction. The age at investigation was 0.2-11.5 years. Fourty-two kidneys were examined. Hydronephrosis existed on the right side in 8 cases, left side in 9 and bilateral in 4 cases. Seventeen kidneys had no obstruction. The scintigraphy was interpreted as normal in 19 kidneys. Decreased isotope uptake was found in 23 kidneys and localized to the upper pole area in 19 kidneys, middle-lateral part in 7, lower pole area in 15 and the middle-medial part in 12 kidneys. There were no predominance for any part of the kidney to be affected by parenchymal damage. In 8 children investigated before the age of 1 year, 4 of 10 hydronephrotic kidneys revealed normal DMSA scintigram. DMSA scintigraphy delineates functioning renal parenchyma. DMSA scintigraphy delineates functioning renal parenchyma. It can be recommended as a routine method for evaluation of the renal parenchyma before surgery and for follow up studies in all ages of childhood.

Topics: Child; Child, Preschool; Female; Humans; Hydronephrosis; Infant; Kidney; Male; Organometallic Compounds; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Ureteral Obstruction

Partial obstruction of the left ureter was created in two-day-old rats and its effects on kidney function were studied with 99mTc-DMSA and 99mTc-DTPA after one, two, three and six weeks, and after one year. Kidneys from animals sacrificed at the age of six weeks or one year were also examined histologically. The obstructed renal pelvis was enlarged by about 35 times and there was a delayed excretion of 99mTc-DTPA during forced diuresis, indicating significant, chronic obstruction. The renal DMSA-uptake ratio (left kidney/(left and right kidney] was reduced to about 40% from the first week of obstruction. The parenchymal weight ratio (expressed as above) was reduced to about 45% after both six weeks and one year. The glomerular filtration rate, examined during forced diuresis and calculated on the basis of uptake capacity, was lowered to 42% after six weeks but was not significantly reduced after one year of obstruction. The incidence figures for medullary hemorrhage or accumulation of iron pigment, and chronic inflammatory changes in the cortex were somewhat higher after one year of obstruction than after 6 weeks, but the lesions were patchy in both groups. We conclude that partial unilateral ureteric obstruction, created in the neonatal period, leads to a slight but permanent functional disturbance and parenchymal weight reduction without prominent structural parenchymal damage.

Topics: Animals; Animals, Newborn; Follow-Up Studies; Hydronephrosis; Kidney; Organotechnetium Compounds; Pentetic Acid; Radioisotope Renography; Rats; Rats, Inbred Strains; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pentetate; Time Factors; Ureteral Obstruction

Topics: Animals; Hydronephrosis; Kidney; Kidney Function Tests; Mannitol; Methylprednisolone; Rats; Succimer

We reviewed 59 cases of ureteropelvic junction obstruction diagnosed in 55 fetuses by echographic examination during prenatal period between 1981 and 1987. Postnatal excretory urograms and voiding cysto urethrography were obtained in all patients. Quantitative renal scans with 99 m technetium labeled dimercaptosuccinic acid or 99 m technetium labeled diethylenetriamine penta acetic acid were used in 49 patients and demonstrated a renal impairment in 19 cases (38%). 8 neonates were not operated, 1 required unilateral nephrectomy and 50 were treated by the Anderson-Hynes surgical procedure. 46 (92%) among those 50 obtained a significant improvement of pelvi-caliceal dilatation or excretion; 4 (8%) only a stabilisation. Early recognition of congenital hydronephrosis is now very common. After birth renal scans provided better estimation of renal function than excretory urograms but for the graduation of the obstruction the data did not appear to be always reliable (10% of false negatives in this study). The real problem is to know within which period of time the neonates whose renal function is impaired need surgery. In our study that question cannot be given a definitive answer because of too few post operative renal scans. However, we think, just as literature data tend to prove, that those neonates required early surgery if normal renal function is to be obtained.

Topics: Female; Fetal Diseases; Humans; Hydronephrosis; Infant, Newborn; Kidney Pelvis; Organometallic Compounds; Pentetic Acid; Pregnancy; Prenatal Diagnosis; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pentetate; Ultrasonography; Ureteral Obstruction; Urography

Topics: Adolescent; Adult; Age Factors; Aged; Child; Child, Preschool; Humans; Hydronephrosis; Infant; Kidney; Middle Aged; Nephrostomy, Percutaneous; Organometallic Compounds; Radioisotope Renography; Succimer; Sulfhydryl Compounds; Technetium Tc 99m Dimercaptosuccinic Acid

99mTc-DMSA and diuretic 99mTc-DTPA renoscintigraphy were performed on 51 kidneys suspected of obstructive nephropathy based on excretory urography to evaluate the residual renal function and the degree of urinary flow impairment respectively. We classified the response to diuretics into 6 patterns: I. normal, IIa. severely damaged renal function, IIb. slow RI excretion without urinary tract visualization (pattern II had no response to furosemide), IIIa. rapid elimination of tracer from the obstructed upper tract, IIIb. slow elimination, and IV. gradual tracer accumulation in the pelvicalyceal system with fairly well preserved renal function but no response. Hydronephrosis varied according to pattern type, in the ascending order of I, IIIa, IIIb and IV (p less than 0.05). Degree of hydronephrosis was inversely related to 99mTc-DMSA uptake, but without statistical significance. 99mTc-DMSA uptake was lower for pattern III as a whole (IIIa + (IIIb) than for pattern I (p less than 0.005), but there was no difference between IIIa and IIIb. Pattern IIa exhibited a significantly lower uptake than any of the other groups. (p less than 0.005) In contrast to previous views, we believe that pattern IIIa indicates a mild obstruction of urinary flow and impaired renal function. Consequently, assessment of obstructive nephropathy should not be based only on urodynamic study but also on differential renal function test.

Topics: Humans; Hydronephrosis; Kidney Calculi; Kidney Diseases; Organometallic Compounds; Pentetic Acid; Radioisotope Renography; Succimer; Sulfhydryl Compounds; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pentetate; Urodynamics

Partial obstruction of the left ureter was created in 19 rats and a relative 99Tcm-DMSA uptake was obtained 5 and 24 h after intravenous injection of the tracer. A systematic and variable overestimation of the left to right uptake ratio was found at 5 h, with a mean error of 15.8% (S.D. = 12.2).

Topics: Animals; Disease Models, Animal; Hydronephrosis; Kidney; Male; Organometallic Compounds; Radionuclide Imaging; Rats; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Time Factors

During a 6-year period (1979-1985), 142 neonates with significant hydronephrosis were seen. Seventy-eight percent of the cases were discovered on fetal screening during obstetric sonography. Maternal/fetal intervention was virtually never indicated and most babies were asymptomatic. The most common conditions found were obstruction of the ureteropelvic junction (41%), obstruction of the distal ureter (usually primary megaureter) (23%), upper-pole hydronephrosis associated with duplex anomalies (13%), and posterior urethral valves (10%). Seventeen neonates with multicystic dysplastic kidney were seen (three per year or one for every eight with hydronephrosis). In comparison, during the 30-year period, 1947-1977, 146 neonates with significant hydronephrosis were seen. Most cases were discovered because the patients had signs and/or symptoms--either an abdominal mass (an enlarged kidney or bladder) or urosepsis. The three most common conditions were obstruction of the ureteropelvic junction (22%), posterior urethral valves (19%), and ectopic ureterocele (14%). During this period, 53 neonates with multicystic dysplastic kidney were discovered (two per year or one for every three with hydronephrosis). The dramatic increase in the number of neonates found to have hydronephrosis is primarily due to the widespread use of obstetric sonography and concomitant fetal screening. The pattern of causes before 1979 represented the incidence of symptomatic lesions. The current pattern more accurately reflects the true incidence of congenital anomalies of the urinary tract.

Topics: Humans; Hydronephrosis; Infant, Newborn; Kidney; Organometallic Compounds; Pentetic Acid; Polycystic Kidney Diseases; Radiography; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pentetate; Ultrasonography; Urethra; Urinary Bladder; Vesico-Ureteral Reflux

A new technique for experimental reversible hydronephrosis in the rat was developed. A noninvasive radioisotopic investigation, using Tc-99m dimercaptosuccinic acid, permitted sequential assessment of the separate renal function at different stages of the study. After 1 week of unilateral ureteral obstruction, reversibility was obtained by the removal of the obstructive device. Ten days after the obstruction release, the ipsilateral kidney had returned to 71 per cent of its preligation uptake value. Histological findings demonstrated the reversibility of the surgical obstruction.

Topics: Animals; Constriction; Disease Models, Animal; Hydronephrosis; Kidney; Male; Methods; Radionuclide Imaging; Rats; Rats, Inbred Lew; Succimer; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Ureter; Ureteral Obstruction

Partial functions of the kidney, i.e. renal blood flow, GFR etc, can be estimated with radionuclide techniques as safe and non-invasive methods. Many methods have been published to distinguish between obstructive and non-obstructive hydronephrosis. A simple and highly relevant technique is the diuretic radionuclide urography which should be done in all patients with questionable urographic or sonographic findings. The evaluation of split renal function is somewhat difficult because tissue absorption will influence uptake determination. In hydronephrosis this absorption cannot be predicted by sonographic measurement of the kidney's depth and mass. A solutions is to calculate the absorption in these patients by stepwise scintigraphy. Continuous quality control of the technique is emphasized.

Topics: Adult; Child; Chronic Disease; Humans; Hydronephrosis; Infant; Iodohippuric Acid; Kidney Function Tests; Radioisotope Renography; Succimer; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid

We studied 17 hydronephrotic kidneys owing to stenosis of the pyeloureteral junction. Preoperative uptake of 99mtechnetium dimercaptosuccinic acid was compared to early postoperative unilateral creatinine clearance, measured by urine collection from the nephrostomy tube. An excellent correlation was found. Therefore, uptake of 99mtechnetium dimercaptosuccinic acid represents a reliable parameter of renal function even in the presence of severe urinary tract obstruction. However, 99mtechnetium dimercaptosuccinic acid uptake should be measured more than 24 hours after injection of the tracer.

Topics: Adolescent; Adult; Creatinine; Female; Humans; Hydronephrosis; Infant; Kidney; Male; Postoperative Care; Preoperative Care; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Ureteral Obstruction

Employing technetium labeled dimercaptosuccinic acid, we predicted the inulin and p-aminohippuric acid (PAH) clearances after recovery of an obstructed kidney before relief of the obstruction. Sixteen rabbits had one renal unit obstructed for varying period of time. The animals were scanned immediately before relief of the obstruction. After 4 to 6 months recovery, inulin and PAH clearances were measured in all animals. The scans were mathematically analyzed, and accurately predicted the inulin and PAH clearances obtained after complete recovery (P less than 0.001 and P less than 0.001, respectively). Six rabbits were scanned at the time of the clearance measurements. By a different mathematical analysis, inulin and PAH clearance measured concurrently correlated with the scan (P less than 0.001 and P less than 0.01 respectively).

Topics: Animals; Hydronephrosis; Inulin; Kidney; Male; Metabolic Clearance Rate; Models, Biological; p-Aminohippuric Acid; Prognosis; Rabbits; Radionuclide Imaging; Succimer; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid

Topics: Adult; Bone Neoplasms; Child; Humans; Hydronephrosis; Iodine Radioisotopes; Iodohippuric Acid; Kidney; Kidney Diseases; Kidney Diseases, Cystic; Male; Pentetic Acid; Prostatic Neoplasms; Radioisotope Renography; Succimer; Technetium