succimer and Kidney-Diseases

Topics: Child; Child, Preschool; Humans; Infant; Kidney; Kidney Diseases; Organotechnetium Compounds; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections

The dimercaptosuccinic acid (DMSA) renal scan is a method for assessing kidney function. Indications for DMSA scanning in children with urinary tract infection (UTI), as well as timing, have changed. Pitfalls in interpreting DMSA scans include: (1) acute pyelonephritis (APN), (2) tubular dysfunction, (3) hypertension, (4) use of captopril in patients with renovascular hypertension and (5) duplex kidneys. Interpretation of DMSA scans in children with UTI vary according to timing and clinical setting. During the course of a febrile UTI a DMSA scan may reveal a normal kidney, APN or a non-functioning, small and/or ectopic kidney. In the absence of UTI (up to 6 months) in children with vesicoureteric reflux a DMSA scan may indicate a normal kidney, renal scarring (reflux nephropathy), occult duplex kidney and allows the progression of scarring and hypertrophy of normal areas of the kidney to be followed anatomically. The DMSA renal scan in now the most reliable test for the diagnosis of APN. The transient abnormalities due to APN can occur in normal or scarred kidneys. Lesions due to reflux nephropathy (defined as a defect in the renal outline or contraction of the whole kidney) are permanent. Intravenous urography reveals renal abnormalities later than the DMSA scan. If abnormalities are seen on a DMSA scan performed during the course of APN it is impossible to predict the outcome: they can progress to permanent scarring or heal completely. An abnormal DMSA scan during a febrile UTI allows the identification of children at risk of developing renal scars. These children should be carefully investigated, maintained on long-term quimioprophylaxis and followed.

Topics: Acute Disease; Animals; Child; Cicatrix; Humans; Injections, Intravenous; Kidney; Kidney Diseases; Organotechnetium Compounds; Pyelonephritis; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections; Urography; Vesico-Ureteral Reflux

Although single photon emission computed tomography (SPECT) imaging has established a place for itself in clinical nuclear medicine for heart and brain studies, its place in renal imaging is not yet clear. Renal SPECT has been subject to limitations imposed by the efficiency of imaging equipment, and has been confined to use with static imaging agents such as technetium-99m (99mTc) dimercaptosuccinate (DMSA). SPECT has been used to investigate space-occupying lesions and anatomical abnormalities, and for quantitative studies of renal uptake and volume. In these areas, it has provided little advantage over conventional imaging, but it has been helpful in individual cases. High-resolution SPECT is a promising new development, which may have applications in detecting and classifying renal scarring. It deserves careful evaluation.

Topics: Humans; Kidney Diseases; Kidney Neoplasms; Organotechnetium Compounds; Radioisotope Renography; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Tomography, Emission-Computed, Single-Photon

Renal cortical scintigraphy has been reported to be useful in children for confirmation of the diagnosis of acute pyelonephritis. Subsequent experimental studies have demonstrated that dimercaptosuccinic acid (DMSA) scintigraphy, when compared directly with histopathology, is highly reliable for the detection and localization of parenchymal inflammatory changes associated with acute pyelonephritis. Recent clinical studies of acute pyelonephritis using DMSA scintigraphy reveal that the majority (50 to 91%) of children with febrile urinary tract infections have abnormal DMSA renal scan findings and that the majority of these children do not have demonstrable vesicoureteral reflux. However, when vesicoureteral reflux is present, renal cortical abnormalities are demonstrated by DMSA scintigraphy in 79 to 86% of the kidneys. In children with febrile urinary tract infections routine clinical and laboratory parameters are not reliable in the differentiation of acute pyelonephritis, documented by DMSA renal scan findings, from urinary tract infections without parenchymal involvement. Furthermore, the presence of P-fimbriated Escherichia coli associated with febrile urinary tract infections does not reliably predict those kidneys that have acute parenchymal inflammation demonstrated by DMSA renal scans. DMSA is also the isotope agent of choice for the detection of renal scarring. Clinical studies report greater sensitivity of DMSA renal scintigraphy for the detection of renal scarring when compared with the excretory urogram, particularly in infants and young children. In a recent prospective study of post-pyelonephritic renal scarring in children we found that acquired renal scarring only occurs in sites corresponding exactly to previous areas of acute pyelonephritis demonstrated by DMSA scintigraphy at the time of infection. Furthermore, once acute pyelonephritis occurs, ultimate renal scarring is independent of the presence or absence of vesicoureteral reflux. These findings provide convincing evidence that renal parenchymal infection, rather than vesicoureteral reflux, is the prerequisite for acquired (postnatal) renal scarring. Vesicoureteral reflux as a risk factor for acquired renal scarring is directly related to its role as a risk factor for acute pyelonephritis. We conclude that DMSA scintigraphy is a valid tool for confirming the diagnosis of acute pyelonephritis in children and for identifying kidneys at risk for subsequent renal scarring.

Topics: Acute Disease; Adolescent; Child; Child, Preschool; Cicatrix; Humans; Infant; Infant, Newborn; Kidney Diseases; Pyelonephritis; Radioisotope Renography; Succimer; Urinary Tract Infections

Radionuclide renal scintigraphy offers a rapid, noninvasive method of determining individual kidney function and evaluating suspected urinary tract disorders. The initial portion of this review describes the advantages and limitations of the currently available renal radiopharmaceuticals and discusses techniques for quantitating renal functions. The latter part of the review addresses the role of radionuclide scintigraphy in the evaluation of the renal transplant, possible obstruction, reflux, renovascular hypertension, trauma, and infection.

Topics: Humans; Kidney Diseases; Kidney Transplantation; Oligopeptides; Organotechnetium Compounds; Radioisotope Renography; Renal Circulation; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Mertiatide

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

Noninvasive radionuclide procedures in the evaluation of renal disease have been accepted increasingly as effective and valuable alternatives to older clinical methods. The development of suitable radiopharmaceuticals labeled with high photon intensity radionuclides and with 99mTc in particular has stimulated this modality during the last few years. Currently several nearly ideal agents are available for anatomical and functional studies of kidney imparting very low absorbed radiation doses. These include 99mTc-GHA and 99mTc-DMSA for renal morphology and differential function evaluation, 99mTc-DTPA for GFR and 123I orthoiodohippurate for ERPF measurements. A suitable agent as a replacement for the latter labeled with 99mTc is actively being sought. Computer-assisted processing of dynamic renal function studies enables the observer to obtain a wealth of information related to the renal extraction, uptake, parenchymal transit and pelvic transit parameters of the agent administered into the bloodstream. Each of these parameters either globally or differentially contributes to a detailed evaluation of renal disease states. Several of these procedures have been validated against classical techniques clinically but more detailed information is being sought with the recently introduced radiopharmaceuticals. With the detailed validation and increasing recognition of the clinical utility of several of the radionuclidic procedures at many centers, it is hoped that radionuclide assessment of renal disorders ultimately will be made available routinely at all medical facilities.

Topics: Carbon Radioisotopes; Chlormerodrin; Chromium Radioisotopes; Diatrizoate; Glomerular Filtration Rate; Humans; Inulin; Iodine Radioisotopes; Iodohippuric Acid; Iothalamic Acid; Kidney Diseases; Mercury Radioisotopes; Organotechnetium Compounds; Pentetic Acid; Radiation Dosage; Radioisotopes; Radionuclide Imaging; Renal Circulation; Succimer; Sugar Acids; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pentetate; Vitamin B 12

Topics: Animals; Dogs; Glomerular Filtration Rate; Humans; Kidney; Kidney Diseases; Kidney Function Tests; Organotechnetium Compounds; Penicillamine; Radionuclide Imaging; Rats; Renal Circulation; Succimer; Sulfhydryl Compounds; Technetium

Topics: Hippurates; Humans; Iodine Radioisotopes; Kidney; Kidney Diseases; Kidney Function Tests; Organotechnetium Compounds; Pentetic Acid; Radionuclide Imaging; Renal Circulation; Succimer; Sugar Acids; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pentetate

A system for defining renal scarring on ultrasound is proposed and compared with DMSA scintigraphy. Renal scarring was assessed with ultrasound in children following urinary tract infection (UTI) using the following criteria: (1) proximity of sinus echoes to cortical surface; (2) loss of pyramids; (3) irregularity of outline; (4) loss of definition of capsular echo; and (5) calyceal dilatation. Three hundred and thirty-nine consecutive ultrasound scans (US) and DMSA scintigrams, comprising 648 kidneys, were performed and reported blindly and the results were compared. Using DMSA scintigraphy as the gold standard, ultrasound had a positive predictive value of 93% and a negative predictive value of 95%. Ultrasound disagreed with DMSA scintigraphy in 5.2% of kidneys. On review of the cases of disagreement where arbitration was possible by comparison with other imaging, ultrasound was incorrect in 10 kidneys and DMSA was incorrect in 13. We conclude that the sensitivity in the ultrasound detection of renal scarring can be greatly improved using this method. If no scars were detected at ultrasound an alternative explanation for an abnormal DMSA scintigram should be sought.

Topics: Adolescent; Age Factors; Child; Child, Preschool; Cicatrix; False Negative Reactions; False Positive Reactions; Female; Humans; Infant; Infant, Newborn; Kidney Diseases; Male; Predictive Value of Tests; Radionuclide Imaging; Sensitivity and Specificity; Succimer; Ultrasonography; Urinary Tract Infections

We determined the level of functional damage to the kidney which inhibits further growth.. Renal functional volume and percent uptake of 34 kidneys with reflux were studied by performing sequential quantitative single photon emission computerized tomography 2 times at a mean interval of 3.2 years.. Change in volume between the initial and repeat studies was 27.2 +/- 28.4% in all 34 kidneys. Change in volume was less than 7% in 8 kidneys and greater than 14% in 26. Receiver operating characteristic curve analysis indicated that 15.6% kidney uptake was associated with 75% sensitivity, 100% specificity and 94% accuracy in distinguishing kidneys with more than 7% from those with less than 7% change in volume. The value of kidney uptake of less than 15.6% was 100% in predicting less than 7% change in volume (positive predictive value) and the value of kidney uptake greater than 15.6% was 93% in predicting more than 7% change in volume (negative predictive value).. Kidney uptake of less than 15.6% represents irreversible impairment of renal growth and indicates permanent damage in kidneys with vesicoureteral reflux.

Topics: Adolescent; Adult; Child, Preschool; Female; Humans; Infant; Kidney Diseases; Male; Organotechnetium Compounds; Sensitivity and Specificity; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Tomography, Emission-Computed, Single-Photon; Vesico-Ureteral Reflux

To develop a method for assessing absolute renal function (as well as morphology) in children, using gamma camera imaging of intravenously injected technetium-99m (99mTc) dimercaptosuccinic acid (DMSA).. Forty-five children (ages 1 week to 10 years; mean, 2.0 years) were imaged using a planar technique in which not only the appearance but the absolute amount of intravenously administered 99mTc DMSA taken up by the kidneys was calculated for each child and compared with contemporaneous determinations of creatinine clearance.. There was a close correlation between the absolute DMSA uptake and creatinine clearance (r = 0.752).. Renal function in children, expressed as creatinine clearance, can be accurately estimated by measuring absolute DMSA uptake with planar gamma camera imaging using 99mTc DMSA.

Topics: Child; Child, Preschool; Creatinine; Female; Humans; Infant; Infant, Newborn; Kidney; Kidney Diseases; Male; Organotechnetium Compounds; Predictive Value of Tests; Radioisotope Renography; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid

99mTc-2,3-di-mercapto-succinic acid (DMSA) is able to be used for the quantitative analysis of individual renal function by calculating the uptake ratio. The purpose of this study is to assess the clinical feasibility of DMSA uptake ratio as compared with 131I-ortho-iodo-hippuran (OIH) renogram pattern. Two hundred eleven cases (191 patients, 1 to 87 years old) with renal disorders and 4 normal volunteers (27.8 +/- 2.4 years old) were studied. Just prior to the DMSA study in the same day, OIH renogram was carried out. They were divided into 6 types by OIH renogram patterns. In 24 cases of normal renogram pattern and normal blood data who were defined as the normal group and 4 normal volunteers, DMSA uptake ratio showed negative correlation with increasing age (r = 0.61, p < 0.05). Patients of the severe impaired functioning and the non functioning patterns showed significantly decreased DMSA uptake ratios as compared with the normal pattern. There was also a significant difference in DMSA uptake between impaired functioning patterns. Compensative hemi-hypertrophy kidneys showed significantly higher DMSA uptake ratios than those of atrophic kidneys. The possibility of the quantitative analysis of the functional compensation was presumed. In conclusion, quantitative analysis of individual renal function using DMSA uptake ratio is considered to be useful to evaluate the renal functional reserve.

Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Child; Child, Preschool; Female; Humans; Infant; Iodine Radioisotopes; Iodohippuric Acid; Kidney; Kidney Diseases; Kidney Function Tests; Male; Middle Aged; Organotechnetium Compounds; Radioisotope Renography; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid

In this case report, we aimed to present our clinical experience in a patient with hydronephrotic and atrophic kidney due to impacted lower ureteral stone.. A 56-year-old male was admitted to our emergency department with flank pain and nausea. A computed tomography scan revealed a 3 cm stone at the distal ureter, causing severe hydroureteronephrosis. Right kidney parenchyma was extremely thin at the medial zone, and some parenchyma was apparent at the upper and lower poles. We planned renal scintigraphy, but it was impossible to perform quickly due to the active appointment list. The patient's kidney was assumed to be atrophic/non-functioning; however, given the long waiting list for renal scintigraphy and the patient's intractable pain, we decided to relieve the patient's pain with urinary drainage. Nephrostomy insertion was denied because of the extra thin parenchyma. About 40 days later, the patient underwent semi-rigid ureterorenoscopy under spinal anesthesia. It was impossible to place a double J stent to the ureter because of the kinked and extremely dilated ureter. So, we decided to place an open-end 6Fr ureter catheter. DMSA renal scintigraphy showed 33% right kidney and 67% left kidney function.. Intractable flank pain might be a predictor of functioning renal parenchyma in hydronephrotic/atrophic kidneys. Renal split function lower than 10% on DMSA scintigraphy might not be an absolute indication of nephrectomy, especially in the obstructed renal unit. Evaluation of renal function after eliminating obstruction might be more reliable.

Topics: Female; Flank Pain; Humans; Kidney Diseases; Male; Middle Aged; Nephrectomy; Nephrons; Succimer; Ureteral Calculi

Improved management for spina bifida (SB) has increased the number of patients transitioning to adult care. This trend increases the importance of maintaining renal function concurrently with bladder function in patients with SB. Dimercaptosuccinic acid (DMSA) renal scanning is an optimal tool for investigating renal insufficiency in children with SB; however, the benefits of DMSA scans in adulthood are unclear. The role of DMSA renal scans for patients with SB during the transition to adulthood (15-25 years of age) to reveal their association with current renal function was investigated.. DMSA renal scanning was routinely performed patients with SB aged 15-25 years concurrently with examination of serum creatinine, serum cystatin C, urinalysis, and blood pressure between January 2006 and August 2016. Hypertension was defined as systolic or diastolic pressure above the age-specific normal range. The estimated glomerular filtration rate (eGFR) using serum creatinine or cystatin C was calculated; decreased eGFR was defined as eGFR below 90 mL/min/1.73 m. Eighty-seven patients (36 males and 51 females) were analyzed. Median age was 19 years (range 15-24 years); 28 patients (32%) had renal scarring. Patients with renal scarring had significantly higher rates of hypertension (n = 13, 46%) and decreased eGFR (n = 5, 18%). However, there was no difference in proteinuria between the groups (Table). The group with renal scarring had significantly lower eGFR.. This study showed that DMSA scans in patients with SB aged between 15 and 25 years were useful for assessing renal scarring despite a history of febrile urinary tract infection. DMSA scans could be performed in all patients with SB in the transition to adulthood to detect renal scarring. This study also showed that renal scarring was associated with hypertension and decreased eGFR in this age group. Treatment with antihypertensive drugs should be considered for patients with SB with renal scarring in this age range to protect renal function.. Spina bifida patients in the age of transition to adulthood with renal scarring already showed signs of chronic kidney disease, suggesting that DMSA renal scans could be useful to identify patients who require close monitoring of renal function.

Topics: Adolescent; Cicatrix; Cross-Sectional Studies; Glomerular Filtration Rate; Humans; Hypertension; Kidney Diseases; Spinal Dysraphism; Succimer; Transition to Adult Care; Young Adult

Previously, we reported that specific lower dose of sodium 2,3-dimercapto-1-propanesulfonic acid (DMPS) which is an antidote to heavy metal intoxication, inversely enhanced cisplatin (CDDP)-induced antitumor activity to S-180 cell-bearing mouse. This activity was only weak with meso-2,3-dimercaptosuccinic acid (DMSA), however. This study investigated the effects of lower doses of DMPS or DMSA on the nephrotoxicity and kinetics of CDDP. Kidney and blood isolated from female mice which received CDDP with or without DMPS or DMSA once daily for 4 days were provided for measuring levels of blood urea nitrogen (BUN) and transporter proteins (OCT2: organic cation transporter; MATE1: multidrug and toxin extrusion) mRNA, and CDDP-originated platinum, and TUNEL staining of renal tubular cells. DMPS or DMSA reduced effectively CDDP-induced BUN, and caused a moderate reduction of platinum in kidney. Additionally, both dimercapto-compounds restored the CDDP-reduced mRNA levels of transporter proteins (OCT2 and MATE1), and apparently suppressed the CDDP-induced apoptosis. These results suggest that DMPS, as well as DMSA, at approximate 17-fold dose (μmol/kg) of CDDP, has an enough potential to reverse the CDDP nephrotoxicity, and concomitant use of DMPS considering both dose and timing for administration is potentially useful for preventing nephrotoxicity and enhancing antitumor activity during CDDP chemotherapy.

Topics: Animals; Antineoplastic Agents; Cisplatin; Dose-Response Relationship, Drug; Female; Kidney; Kidney Diseases; Mice; Organic Cation Transport Proteins; Organic Cation Transporter 2; RNA, Messenger; Succimer; Unithiol

We studied the effect of silymarin and dimercaptosuccinic acid (DMSA), a chelating agent that was administered individually or in combination against lead (Pb) toxicity in rats. Wistar rats (200 ± 20) were randomly divided into five groups. Group A served as a control. Groups B-E were exposed to 2000 ppm of lead acetate in drinking water for 8 weeks. Group B served as a positive control. Group C received silymarin (100 mg kg(-1) orally) for 8 weeks. Group D received DMSA (75 mg kg(-1) orally) once daily for the last 5 days of treatment. Group E received DMSA and silymarin as groups C and D, respectively. The effect of Pb was evaluated and accordingly the treatments on blood lead levels (BLLs), renal system, and genotoxic effects were calculated using comet assay. The BLLs were significantly increased following the exposition of lead acetate. The administration of silymarin and DMSA provided reduction in BLLs. Silymarin and DMSA provided significant protection on the genotoxic effect of Pb. The toxic effect of Pb on kidneys was also studied. Our data suggest that silymarin and DMSA improve the renal histopathological lesions.

Topics: Animals; Antidotes; Kidney Diseases; Lead; Male; Random Allocation; Rats; Rats, Wistar; Silymarin; Succimer

Vesicoureteric reflux is usually managed medically. When medical management fails, the patient is referred for surgical intervention. The aim is to protect the kidneys from progressive damage. This study investigates if significant kidney damage has occurred during medical treatment prior to surgical intervention.. Case notes of all children treated with ureteric re-implantation for vesicoureteric reflux in a 5-year period were reviewed. Demographic details, radiological investigations, surgery and follow-up were recorded. Indication for surgery was failure of medical treatment. Kidney damage was defined as the presence of a scar on the DMSA scans and/or kidney function below 45% in one kidney.. Forty-two patients underwent ureteric re-implantation with 24 having a bilateral procedure resulting in a total of 66 renal units. Mean age at surgery was 7.4 years. Thirty-eight kidneys (58%) showed reduced function prior to medical treatment. Twenty-four kidneys (36%) had deterioration of renal function associated with recurrent urinary tract infections during the course of medical treatment with the overall mean function of the worst affected kidney being 28%. Thirty-five patients (83%) demonstrated scarring on their kidneys on DMSA scan prior to surgery.. More than half of patients who eventually need ureteric re-implantation for vesicoureteric reflux have already suffered kidney damage prior to start of medical treatment. A third will have progressive deterioration of their renal functions. Early referral for medical management coupled with early surgical intervention in selected cases should hopefully reduce the number of children with renal damage due to VUR.

Topics: Adolescent; Child; Child, Preschool; Cicatrix; Female; Follow-Up Studies; Humans; Kidney; Kidney Diseases; Kidney Function Tests; Male; Replantation; Retrospective Studies; Succimer; Time Factors; Treatment Failure; Ureter; Vesico-Ureteral Reflux

Routine radiological evaluation in children with urinary tract infections includes ultrasound. Additional dimercapto-succinic acid scintigraphy in this setting is a common but not routine practice to determine whether there is parenchymal injury. Because dimercapto-succinic acid scintigraphy involves further time, expense and radiation, we determined whether ultrasound findings could substitute for dimercapto-succinic acid scintigraphy. Therefore, in children with urinary tract infections we researched the incidence of discordant findings between dimercapto-succinic acid scintigraphy and normal ultrasound.. A retrospective review of children with a history of urinary tract infections who had normal ultrasound and dimercapto-succinic acid scintigraphy within 6 weeks of each other was performed through a chart review. Children with pyelonephritis within 4 months of the radiological tests were excluded. Dimercapto-succinic acid scintigraphy was considered abnormal if there was less than 40% differential function, global atrophy or focal defects.. From January 2005 to December 2006, 100 children met inclusion criteria. Median patient age was 4.5 years (range 4 months to 19 years) and 84% were female. Of the 100 children 74 (74%) demonstrated vesicoureteral reflux and 18 (18%) showed abnormal dimercapto-succinic acid scintigraphy despite normal ultrasound. Children with vesicoureteral reflux showed an increased incidence of abnormal dimercapto-succinic acid scintigraphy compared to those without vesicoureteral reflux (20.3% vs 11.5%), although this did not attain statistical significance (p = 0.04).. Although dimercapto-succinic acid scintigraphy is not part of routine practice in all children with urinary tract infections and/or vesicoureteral reflux, it is frequently abnormal despite normal ultrasound. Therefore, dimercapto-succinic acid scintigraphy should be considered in these patients to evaluate cortical defects and possibly guide further management.

Topics: Adult; Child; Child, Preschool; Female; Humans; Infant; Kidney Diseases; Male; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Succimer; Ultrasonography; Urinary Tract Infections; Vesico-Ureteral Reflux

Topics: Cicatrix; Humans; Kidney Diseases; Pyelonephritis; Radionuclide Imaging; Succimer; Urinary Tract Infections; Vesico-Ureteral Reflux

Topics: Animals; Chelating Agents; Child; Child, Preschool; Cicatrix; Female; Guidelines as Topic; Humans; Infant; Kidney; Kidney Diseases; Male; Succimer; Sweden; Swine; United Kingdom; Urinary Tract Infections; Vesico-Ureteral Reflux

Topics: Amyotrophic Lateral Sclerosis; Chelating Agents; Gases; Humans; Kidney Diseases; Mercury Poisoning, Nervous System; Succimer

Topics: Anti-Bacterial Agents; Drug Administration Schedule; Early Diagnosis; Female; Humans; Infant; Kidney Diseases; Male; Prognosis; Radionuclide Imaging; Risk Assessment; Severity of Illness Index; Succimer; Treatment Outcome; Urinary Tract Infections

Vesico-ureteral reflux (VUR) is the most common inherited disorder of the lower urinary tract. Children with VUR are at risk for ongoing renal damage with subsequent infections. IL8 is an important inflammatory mediator which can be produced by epithelial cells of the renal tract in response to a variety of inflammatory stimuli. High serum concentrations of IL-8 have been reported in patients with chronic renal failure. Elevated IL-8 levels have been reported in the urine of patients with VUR and renal parenchymal scarring (RPS). More recently it was reported that urine IL-8 levels remain elevated in infants with VUR even in the absence of a urinary tract infection (UTI). Increased IL-8 expression has been shown to be associated with polymorphism at position -251 (rs4073) of the IL-8 promoter. The aim of this study was to examine the association of IL-8 gene polymorphism with familial VUR in a cohort of 219 siblings from 109 families affected with VUR, the largest such cohort tested to date. RPS was assessed using dimercaptosuccinic acid scintigraphy. Genotyping was performed in 219 siblings with VUR (157 without RPS, 62 with RPS) and 292 controls for the position -251 of IL-8 gene by polymerase chain reaction with tetra primers and gel analysis. Genotype was compared using the chi square test. Statistical significance was taken as a value of P < 0.05. There were no significant differences in IL-8 -251 genotype frequency between VUR patients and controls. Similarly, gender, severity of VUR and renal parenchymal scarring had no effect on IL-8 -251 genotype frequency. Although IL-8 urinary levels have been reported to be elevated in VUR, our data indicate that IL-8 gene is not involved in the pathogenesis of familial VUR or reflux nephropathy.

Topics: Chelating Agents; Cohort Studies; Female; Genetic Predisposition to Disease; Humans; Interleukin-8; Kidney; Kidney Diseases; Male; Polymerase Chain Reaction; Polymorphism, Genetic; Radionuclide Imaging; Sex Distribution; Siblings; Succimer; Vesico-Ureteral Reflux

To determine if dimercaptosuccinic acid (DMSA), an agent originally developed as a safe non-toxic antidote for heavy metal poisoning, would be useful as a kidney radiation dose reduction agent in patients undergoing radiopeptide therapy for cancer.. Thirty-six adult male Wistar rats were injected via the penile vein with 10 MBq of 177Lu-DOTA-tyr(3)-octreotate. At 30 min after the radiopeptide injection, 18 of the animals (intervention group) were injected with 0.15 mg x g(-1) of DMSA (i.p.). Samples were collected for gamma counting at 24 (n=12), 48 (n=12) and 72 h (n=12) after administration of the radiopeptide. At each time point, the percentage injected dose per gram of tissue in each sample of the six control animals was compared with that of the six animals from the DMSA injection regimen.. The i.p. injection of 0.15 mg x g(-1) of DMSA 30 min following the administration of the 177Lu-DOTATATE reduced the mean (95% CI) kidney retention of radiopeptide by 15.6% (2.6-24.6) at 72 h while not significantly affecting uptake in other organs. Statistical testing of the difference between the two groups of animals (DMSA versus controls) at 72 h post-administration of the radiopeptide indicated only a 3% chance that the magnitude of the reduction in kidney radiopeptide retention observed would be expected due to natural variation (i.e., if there was no difference between the groups).. This study has indicated that DMSA has the potential to selectively reduce radiopeptide kidney retention. Further work is necessary to determine the most effective dose of DMSA and the most effective timing regimen, and to examine the clinical efficacy of several other chelating agents.

Topics: Animals; Body Burden; Chelating Agents; Drug Evaluation, Preclinical; Kidney; Kidney Diseases; Male; Metabolic Clearance Rate; Neuroectodermal Tumors; Octreotide; Organ Specificity; Peptides; Radiation Dosage; Radiation Injuries; Radiation-Protective Agents; Radiopharmaceuticals; Rats; Rats, Wistar; Succimer; Treatment Outcome

There is an ongoing debate over the radiological investigations of children with urinary tract infections (UTIs) with some authorities suggesting that ultrasound scan (USS) alone is an accurate tool to diagnose renal parenchymal scarring post-pyelonephritis. All studies on this subject have been performed at paediatric teaching centres whereas most children with UTIs are managed by General Paediatricians in District General Hospitals (DGHs) in the United Kingdom. We wished to identify whether results of scans in DGHs differed from those in teaching centres.. We looked at all children with a clinical history of UTIs having a DMSA and USS over a one year period in two DGHs and one teaching centre. A total of 476 children's results were reviewed, 297 from the DGHs and 179 from the teaching centre.. The cohort had a total of 949 renal units. There were 79 scarred renal units (kidneys) on DMSA (8%) in 72 patients (15%). Just 18 renal units were detected as being scarred on USS (22.8%). Nine of 32 scarred renal units in the teaching centre were detected compared with nine of 47 in the DGHs (P = 0.40). Thirty-nine (49%) of the scarred renal units were in patients >5-years old. Of these 12 (30.7%) were detected on USS, nine of 17 within the teaching centre compared with just three of 22 at the DGHs (P = 0.01).. Overall only a small percentage of scars are detected on USS. In the over 5-year old group, where USS alone might be preferred, DGHs were significantly worse at detecting scarred kidneys. We conclude that if the detection of renal scars is a prime reason for imaging in children with UTIs, ultrasonography alone is inappropriate at any age and DMSA ought to be the primary investigation.

Topics: Chelating Agents; Child; Child, Preschool; Cicatrix; Cohort Studies; Female; Humans; Infant; Kidney; Kidney Diseases; Male; Reproducibility of Results; Retrospective Studies; Succimer; Ultrasonography; Urinary Tract Infections

Thirty operated patients of myelodysplasia were clinically evaluated for the age at presentation, the extent of lesion and neurological deficit. Urological assessment was done with urine cultures, serum creatinine, radiological (ultrasound of kidney, ureters and bladder, voiding cystourethrogram) and urodynamic (water cystometry) parameters. An objective scoring for bladder (Galloway, et al.) was applied. Dimercapto-succinic acid (DMSA) scan was done in all the patients for evidence of renal scars. The results of above investigations were correlated with presence or absence of renal scars (renal injury) on DMSA scan. None of the patients had received any prior bladder care.. Twenty one patients had no renal scars and 9 patients had evidence of renal scarring. Patients with renal scars were older at presentation, they had greater degree of hydroureteronephrosis (P < or = 0.001) and vesicoureteric reflux (P < or = 0.005). The incidence of high leak pressures (>25 cm of water, P < or = 0.05), unacceptable bladder volumes (maximum cystometric capacity < 60% for age, P < or = 0.005) and high risk Galloway's score (> 5, P < or = 0.05) was high in patients with associated renal scarring as compared to their nonscarred counterparts. Three of these patients had serum creatinine >1 mg/dl (P < or = 0.005). The incidence of urinary complaints and positive urine cultures was also higher in these patients (NS).. Increasing age, evidence of hydroureteronephrosis and vesicoureteric reflux, high leak pressures, low bladder volume and high combined Galloway score (>5) define a high risk bladder in our population and predispose to renal injury in patients of myelodysplasia. Early referral for bladder risk assessment and management of all myelodysplasia patients is recommended.

Topics: Age Factors; Female; Humans; Incidence; India; Kidney Diseases; Male; Meningomyelocele; Prospective Studies; Risk Assessment; Risk Factors; Succimer

This study determines why kidney transplants develop new focal defects.. Thirty children at a U.K. pediatric nephrology department receiving kidney transplants had early and late dimercaptosuccinic acid (DMSA) scans to detect acquired focal defects, and their presence correlated with possible risk factors. Associations between clinical events and focal DMSA lesions appearing in grafts were measured.. Of the 30 early DMSA scans (within 2 weeks of function), one child with a thrombosed polar artery had a focal defect. On rescanning later, 11 (37%) had acquired segmental defects; five were multiple, and their glomerular filtration rates were 20 ml/min/1.73 m lower (95% CI 7-34). Histology in one case showed pyelonephritic scarring. Reflux into the transplant ureter occurred in 19/27 (70%) of children tested (by radiological or indirect radionuclide cystography). Nine of 13 children (69%) who had a combination of reflux and a urine infection had acquired scars, whereas only 1/14 (7%) did without this combination (P = 0.001). Scarring was not associated with the age or sex of the donor or recipient, rejection episodes, renal biopsy, or drug-induced nephrotoxicity.. Kidney transplants are at high risk of developing segmental pyelonephritic scars if infected urine refluxes into the graft, either early through a transanastomotic stent or later from vesicoureteric reflux. These scars may reduce the renal function and are readily seen on DMSA, but not ultrasound scans. Consideration should be given to more effective antireflux surgery for transplants, with subsequent testing for reflux, urinary antibiotic prophylaxis, and prompt treatment of urine infections.

Topics: Adolescent; Adult; Chelating Agents; Child; Female; Humans; Kidney; Kidney Diseases; Kidney Transplantation; Living Donors; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Tissue Donors

We report a girl with extra-adrenal pheochromocytoma complicated with impaired renal function of the ipsilateral kidney, discussing aetiologies. A 14-year-old girl presented with uncontrolled hypertension, high urinary vanillylmandelic acid level and a 5 x 6 cm mass at the right renal hilum. Her blood pressure was under control with propranolol, prazosin, and nifedipine before surgery, and with sodium nitroprusside during surgical intervention. The total tumour removal required reconstruction of the right renal vein. Histopathology confirmed pheochromocytoma. Dimercaptosuccinic acid (DMSA) after surgery showed low uptake of isotope by the right kidney; it was unclear if this was due to the surgery or the tumour causing renal artery stenosis, but fortunately her blood pressure returned to normal thereafter. We recommend obtaining a DMSA in the preoperative evaluation of pheochromocytoma.

Topics: Adolescent; Adrenal Gland Neoplasms; Blood Pressure; Female; Humans; Hypertension; Image Enhancement; Kidney; Kidney Diseases; Kidney Function Tests; Pheochromocytoma; Postoperative Period; Radionuclide Imaging; Succimer; Tomography, X-Ray Computed

Dimercaptosuccinic acid (DMSA) renal scan is presently the technique of choice for assessing renal scars. Recent advances suggest that ultrasonography could replace DMSA scan for this purpose. This paper describes the experience of a tertiary pediatric referral hospital performing ultrasonography and DMSA scans in the assessment of renal scarring. Investigations were conducted 3-6 months after patients presented with urinary tract infection (UTI). Results were extracted from the radiology information system and recorded for analysis. All children with a UTI who had undergone DMSA and ultrasound examination on the same day between January 1995 and December 1999 were included; 930 kidneys were compared. DMSA scan was utilized as the reference method. When used to detect focal renal scarring, ultrasonography had a sensitivity of 5.2%, specificity of 98.3%, a positive predictive value (PPV) of 50% and a negative predictive value (NPV) of 75.8%. When used to detect diffuse renal scarring, ultrasonography had a sensitivity of 47.2%, specificity of 91.8%, PPV of 60.8% and NPV of 86.6%. Our results demonstrate that although ultrasonography has a good specificity for the detection of renal scarring compared with DMSA, it has low sensitivity, PPV and NPV. Ultrasonography cannot be substituted for DMSA scan in the evaluation of focal renal scarring.

Topics: Child; Cicatrix; Humans; Kidney Diseases; Predictive Value of Tests; Radionuclide Imaging; Sensitivity and Specificity; Succimer; Ultrasonography

The combined therapeutic potentials of lipoic acid and dimercaptosuccinic acid were compared against their sole administrations in restoring the altered lead sensitive indices in urine and isolated renal brush-border preparations. Toxicity was induced in male albino rats (Wistar strain) by administering lead acetate (0.2%) in drinking water for 5 weeks, followed by therapy comprising lipoic acid (25 mg/kg body weight) and dimercaptosuccinic acid (20 mg/kg body weight) solely as well as combined during the 6th week. Changes in kidney weights encountered upon lead administration improved after therapy with lipoic acid and dimercaptosuccinic acid. Renal integrity was assessed by measuring the activities of alkaline phosphatase, acid phosphatase, lactate dehydrogenase, leucine aminopeptidase, N-acetyl-beta-D-glucosaminidase, gamma-glutamyl transferase and beta-glucuronidase in urine along with some urinary constituents (urea, uric acid, creatinine, protein and phosphorous). The effects of lead were also studied on isolated brush-border enzymes (alkaline phosphatase, acid phosphatase, gamma-glutamyl transferase and beta-glucuronidase) that showed a decline upon its administration. Increased activities of urinary enzymes were accompanied by increase in the urinary constituents. Increase in renal lead content was paralleled by a drastic fall in the renal delta-aminolevulinic acid dehydratase and a rise in urinary lead levels. Relative to the administration of lead, the combined therapy showed betterment on the renal integrity with respect to the functional parameters assessed, thereby indicating its efficacy over the monotherapies.

Topics: 5-Aminolevulinate Synthetase; Animals; Antioxidants; Biomarkers; Body Weight; Chelating Agents; Disease Models, Animal; Drug Therapy, Combination; Kidney Cortex; Kidney Diseases; Kidney Tubules; Lead Poisoning; Male; Microvilli; Organ Size; Organometallic Compounds; Rats; Rats, Wistar; Succimer; Thioctic Acid

Topics: Adolescent; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Kidney Diseases; Male; Pediatrics; Radioisotope Renography; Radiopharmaceuticals; Succimer; Urologic Diseases; Vesico-Ureteral Reflux

Children with fully recessive (Type I/I) cystinuria have a high risk of stone formation in the first decade of life. To assess the tendency for cystine to precipitate in individual urine samples, we developed an in vitro assay in which radiolabelled cystine (4mM) was dissolved in urine at 37 degrees C after alkalization to pH 10. Samples were then brought to pH 5, cooled, and centrifuged. The % decrease in supernatant cpm was used as a measure of cystine precipitation (CP). CP varied widely among normal children (74%+/-34) whereas variability of repeated determinations on a single adult individual was modest (64%+/-3.3). The assay was used to compare various potential therapies for cystinuria. Precipitation of exogenous cystine from normal urine was strongly inhibited by addition of D-penicillamine (CP: 8%+/-3) or dimercaptosuccinic acid (DMSA) (CP: 5%+/-1), at urinary concentrations attained by standard oral doses of each drug. Mercaptopropionylglycine (MPG) was moderately effective (CP: 43%+/-9), whereas captopril was a weak inhibitor (CP: 63%+/-12). Precipitation of endogenous cystine (2191 micromol/L) from a cystinuric patient showed that DMSA and D-penicillamine were again highly effective compared to the other agents. In addition DMSA and penicillamine added to the same patient's urine reduced the free cystine by 50% (as measured by automated amino acid analyzer) whereas MPG and captopril had no effect. In conclusion, DMSA is comparable to D-penicillamine as an in vitro inhibitor.

Topics: Adolescent; Age Factors; Chemical Precipitation; Child; Child, Preschool; Cystine; Cystinuria; Dose-Response Relationship, Drug; Humans; Infant; Kidney Diseases; Lithiasis; Penicillamine; Reference Values; Succimer; Tiopronin; Urine

We aimed to investigate, by means of dimercaptosuccinic acid (DMSA) scan, the relations between vesicoureteral reflux (VUR) and its degree, pyelonephritis during infancy, and renal parenchymal findings. Seventy-four infants with pyelonephritis, 44 girls and 30 boys (mean age at their first pyelonephritic episode 4.12 months, median 3 months), were enrolled in the study. Voiding cystourethrography (VCU) and ultrasonography (US) were performed within 6 weeks following the infection. DMSA was performed at least 4 months after the urinary tract infection (UTI). The renal parenchymal pathology was defined as focal or multifocal defects or as a split renal uptake of less than 45%. DMSA scintigraphy revealed that 19% (14/74) of the children had renal damage. Renal parenchymal findings were observed only when VUR was present, and its grade was above 3/5. No abnormality was found in 51 renal units without reflux, 9 with VUR grade 1/5, and 54 with grade 2/5. Renal pathology was observed in 9/24 renal units with VUR grade 3, 3/8 with grade 4, and 2/2 with grade 5. No correlation was found between renal parenchymal defects and clinical presentation of the pyelonephritis, type of the microorganism, presence of bacteremia, or the number of recurrent infections. In adequately treated infants, renal damage is probably due to a reflux-associated, preexisting, congenital renal parenchymal pathology and not to the inflammatory process. We suggest that DMSA scintigraphy should not be performed routinely in every infant with UTI and should be reserved primarily for children with VUR grade 3 and above.

Topics: Cicatrix; Female; Humans; Infant; Infant, Newborn; Kidney Diseases; Male; Pyelonephritis; Radiography; Radionuclide Imaging; Succimer; Ultrasonography; Urethra; Urinary Bladder; Vesico-Ureteral Reflux

The authors evaluated the importance of positive sonographic findings in acute childhood pyelonephritis.. A total of 290 children (91 boys, 199 girls, aged 4 days to 15 years [median, 394 days]) with clinically suspected acute pyelonephritis underwent initial renal gray-scale ultrasound (US) and dimercaptosuccinate scintigraphic examination within 3 days of onset. A total of 173 patients underwent color or energy US examination. One hundred fifteen children with normal scintigraphic or pathologic findings (other than acute pyelonephritis) were excluded from further study; 170 patients with abnormal scintigraphic findings underwent follow-up scintigraphic scanning 60-90 days later.. When pathologic structures other than acute pyelonephritis were not considered, the diagnostic value of gray-scale US was poor, with a sensitivity of 45.5%, a specificity of 86.6%, a positive predictive value of 88.8%, and a negative predictive value of only 40.6%. In regard to future renal scarring, gray-scale US had a positive predictive value of 67.7%, a negative predictive value of 40%, and a likelihood ratio of 1.16. Abnormal Doppler findings helped predict future scarring with a positive predictive value of 85.7%, a negative predictive value of 37.2%, a very low sensitivity of 26.9%, a high specificity of 90.6%, and a likelihood ratio of 2.87.. Positive US Doppler findings in children with clinically suspected acute pyelonephritis indicate the need for immediate treatment. A positive initial gray-scale US examination does not predict future renal scarring, but a positive Doppler examination indicates a high probability of scarring. Negative gray-scale or Doppler US does not exclude a diagnosis of acute pyelonephritis and it cannot predict an absence of future scarring.

Topics: Acute Disease; Adolescent; Chelating Agents; Chi-Square Distribution; Child; Child, Preschool; Cicatrix; False Positive Reactions; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Kidney Diseases; Likelihood Functions; Male; Predictive Value of Tests; Pyelonephritis; Radionuclide Imaging; Sensitivity and Specificity; Succimer; Ultrasonography, Doppler; Ultrasonography, Doppler, Color

The general belief about the relation between risk of renal sequelae after pyelonephritis and age is that infants are at highest risk and children older than 5 years at lower risk. This assumption has led to differences in treatment based on age. The aim of this prospective study was to investigate the occurrence of renal lesions in children aged 0-16 years.. Between May, 1994, and January, 1996, all children aged 0-16 years who were admitted to our department with a diagnosis of probable pyelonephritis and a positive urine culture were included in this prospective study. All patients received antibiotics for 7-21 days. During the acute phase of urinary-tract infection, scintigraphy with technetium-99m-dimercaptosuccinic acid (DMSA) and ultrasonography were done. Voiding cystourethrography was undertaken at least 6 weeks after the end of antibiotic treatment. When scintigraphy showed renal parenchymal lesions, repeat scintigraphy was done after at least 2 months to assess the progression of renal lesions. For the analysis, children were grouped by age according to presumed risk of renal sequelae after pyelonephritis: high risk (< 1 year), moderate risk (1-5 years), low risk (> 5 years).. 201 patients were enrolled in the study (119 < 1 year, 47 aged 1-5 years, 35 > 5 years). During the acute phase of urinary-tract infection, renal lesions were found in 66 (55%) infants under 1 year, in 37 (79%) children aged 1-5 years, and in 24 (69%) children older than 5 years. Of these 127 children, 108 underwent repeat scintigraphy after an average of 3 months (50 < 1 year, 36 aged 1-5 years, 22 > 5 years). Overall, renal scars were found on repeat scintigraphy in 20 (40%) infants under 1 year, in 31 (86%) children aged 1-5 years, and in 14 (64%) children older than 5 years. 38 (36%) of these 65 patients had vesicoureteric reflux. Among 88 children who had a first documented urinary-tract infection and underwent repeat scintigraphy, renal scars were found in 20 (43%) under 1 year, in 26 (84%) aged 1-5 years, and in eight (80%) older than 5 years.. This study did not confirm the conventional view that the risk of renal scars after pyelonephritis diminishes with age. We believe that all children, irrespective of age, will benefit from any measure that prevents the development of renal sequelae.

Topics: Adolescent; Age Factors; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Bacterial Infections; Child; Child, Preschool; Cicatrix; Disease Susceptibility; Humans; Infant; Infant, Newborn; Kidney Diseases; Organotechnetium Compounds; Prospective Studies; Pyelonephritis; Recurrence; Risk; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Ultrasonography; Vesico-Ureteral Reflux

Accurate diagnosis of pyelonephritis using clinical and laboratory parameters is often difficult, especially in children. The main aims of this prospective study were to compare the value of different imaging techniques [renal sonography, cortical scintigraphy with technetium-99m dimercaptosuccinic acid (99mTc DMSA) and computed tomography (CT)] in detecting renal involvement in acute urinary tract infections and to determine the sensitivity of DMSA scans for permanent renal scars 6 months later.. Between February 1992 and January 1993, 55 children admitted to our pediatric unit with febrile symptomatic urinary tract infections were eligible for analysis. Ultrasonography (US), DMSA scanning and micturating cystourethrography were performed in every case. Only 18 children underwent CT. A second DMSA scan was performed in 48 children a mean of 7.5 months after the first.. US abnormalities were found in 25 children (45 %). The first DMSA scan showed a parenchymal aspect suggestive of pyelonephritis in 51 patients (93 %). Among the 18 patients studied by CT, 14 had abnormalities. Normal US findings did not rule out renal parenchymal involvement. Scintigraphy appeared to be more sensitive than CT for renal involvement. The frequency and degree of initial renal parenchymal damage seemed to correlate with vesicoureteral reflux, but the most severe initial parenchymal defects were not associated with marked clinical or laboratory manifestations. Repeat DMSA scans, performed on 45 kidneys with abnormalities at the first examination, showed resolution in 19, improvement in 16, persistence in 8 and deterioration in 2. The prevalence of vesicoureteral reflux was not higher in patients with renal scarring on the second DMSA scan than in patients whose scans showed an improvement.. DMSA scans should be considered as a reference in the detection and follow-up of renal scarring associated with acute urinary tract infection as this technique is more sensitive than US and CT, the latter being unsuitable because it entails radiation exposure and sedation of patients.

Topics: Acute Disease; Adolescent; Child; Child, Preschool; Cicatrix; Diagnostic Imaging; Disease Progression; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Kidney; Kidney Diseases; Male; Organotechnetium Compounds; Prevalence; Prospective Studies; Pyelonephritis; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Tomography, X-Ray Computed; Ultrasonography; Urethra; Urinary Bladder; Urinary Tract Infections; Urination; Vesico-Ureteral Reflux

We evaluated data collected for 10 years on children with reflux nephropathy to identify a means of predicting the prognosis.. A total of 15 boys and 13 girls were enrolled in this study at least 2 years after surgical and spontaneous resolution of vesicoureteral reflux in 25 and 3 patients, respectively. They were followed for more than 10 years and renal function was periodically evaluated. Urinary beta 2-microglobulin, alpha 1-microglobulin, N-acetyl-beta-D-glucosaminidase, microalbumin and 99mtechnetium dimercapto-succinic acid uptake were measured.. Of the 28 patients 12 had high levels of urinary alpha 1-microglobulin during followup, including all 7 in whom renal function deteriorated. In 3 children with elevated alpha 1-microglobulin urinary microalbumin gradually increased after puberty. Although elevated levels of urinary beta 2-microglobulin, N-acetyl-beta-D-glucosaminidase and microalbumin were also observed, they were less predictive of renal function than alpha 1-microglobulin.. These results suggest that elevated urinary levels of alpha 1-microglobulin may predict the risk of abnormal renal function in children with reflux nephropathy even before the appearance of significant proteinuria.

Topics: Acetylglucosaminidase; Adolescent; Albuminuria; Alpha-Globulins; beta 2-Microglobulin; Child; Child, Preschool; Cicatrix; Female; Follow-Up Studies; Humans; Kidney; Kidney Diseases; Kidney Function Tests; Male; Predictive Value of Tests; Prognosis; Sensitivity and Specificity; Succimer; 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

Established renal scarring represents areas of the kidney that imaging reveals to be damaged at presentation for medical management of urinary tract infection. New renal scarring represents new renal damage in parts of the kidney that imaging reveals to be normal at presentation. We attempted to characterize patients in whom new renal scars developed while they were under our care.. In 1988 a data base was started to identify patients with new renal scarring. All patients presenting with urinary tract infections were enrolled. Our data base has 250 possible fields per event with multiple events per patient. More than 2,100 patients have been enrolled to date. All patients with pyelonephritis, defined as a febrile urinary tract infection with flank pain and tenderness, and all with reflux underwent dimercapto-succinic acid (DMSA) scan at least 4 months after presenting with infection to assess established renal scars. New renal scars were identified when new renal defects were demonstrated on a second DMSA scan.. In our data base there are 1,426 patients with urinary tract infections, 685 (46%) with pyelonephritis and 1,062 (74.5%) with vesicoureteral reflux, including 558 found to have bilateral vesicoureteral reflux and 504 diagnosed with unilateral reflux. A history of daytime urinary incontinence was noted in 538 patients (37.7%), 192 (13.5%) had established scars at initial presentation and in 31 (2.1%) new renal scars developed while they were under our care, including 30 with established scars as well. Of the 25 patients in whom new renal scars developed while on medical therapy 11 underwent surgery. In 6 patients with dysfunctional voiding who were receiving medical treatment renal scars developed postoperatively. Surgery was performed in 17 of the 31 patients and 24 (77%) with new renal scars had a history of dysfunctional voiding.. Previous characterizations of patients with new renal scars have relied on excretory urography for assessing renal architecture and ignored voiding patterns of the children affected. Using the DMSA scan we identified 31 children with reflux, urinary tract infection and dysfunctional voiding in whom new renal scars developed while they were under our care.

Topics: Adolescent; Child; Child, Preschool; Cicatrix; Female; Humans; Infant; Kidney Diseases; Male; Prospective Studies; Pyelonephritis; Radiography; Succimer; Urinary Incontinence; Urinary Tract Infections; Vesico-Ureteral Reflux

Significant uptake and retention of 99Tc(m)-dextran (molecular weight: 81,000) in renal parenchyma was discovered during evaluation of its intravascular use. Renal SPET images confirmed this. This study was designed to evaluate 99Tc(m)-dextran as a renal cortex imaging agent. Stability of parenchymal retention was shown by insignificant outflow at 24 h and by frusemide intervention. Evaluation of the renal parameters of intravenous 99Tc(m)-dextran (n = 71 normal kidneys) and its comparison with 99Tc(m)-DTPA n = 10) and 99Tc(m)-DMSA(III) (n = 23) was undertaken. The early glomerular extraction phase of the renograms of 99Tc(m)-DTPA and 99Tc(m)-dextran appeared identical; parenchymal uptake of 99Tc(m)-dextran continued to increase and reached a near-plateau by 40-60 min. The mean cortex-to-background and cortex-to-liver ratios at 2 h with 99Tc(m)-dextran and 99Tc(m)-DMSA(III) were 14.9 and 9.2, and 16.0 and 8.9, respectively. The target-to-nontarget ratios were similar despite different absolute renal uptake values (12 vs 20% at 2 h) because of faster background clearance of 99Tc(m)-dextran. The mechanism of parenchymal retention of 99Tc(m)-dextran appears to be trapping at the endothelial-epithelial interphase of the glomerulus. Our initial experience suggests 99Tc(m)-dextran is a viable renal parenchyma imaging agent.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Dextrans; Female; Furosemide; Humans; Injections, Intravenous; Kidney Cortex; Kidney Diseases; Male; Metabolic Clearance Rate; Middle Aged; Organotechnetium Compounds; Radiopharmaceuticals; Reagent Kits, Diagnostic; Reference Values; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pentetate; Tissue Distribution; Tomography, Emission-Computed, Single-Photon

Congenital maldevelopment is sometimes found in small kidneys with ureteral reflux. However, the incidence of congenitally small kidneys and the frequency of its association with ureteral reflux remains unknown. Ultrasound scanning, performed in 4,000 apparently healthy neonates or young infants (males 2,129, females 1,871), detected 51 children suspected of having small kidneys. A careful ultrasound re-examination performed one month later in 45 of the 51 children confirmed small kidneys in eight children, one bilateral and seven unilateral. Dimercaptosuccinate (DMSA) renoscintigraphy revealed small kidneys with generally diminished uptake in six infants and no uptake unilaterally in the other two infants. One of the 12 children, who had normal findings on the initial scanning and subsequently developed urinary infection, was later diagnosed having unilateral small kidney with generally reduced DMSA uptake. All seven infants having small kidneys with reduced tracer uptake were male (incidence, 1:300 boys). All eight small kidneys in the seven boys and four of the six contralateral non-small kidneys were associated with ureteral reflux, while neither of the two infants with a non-functioning kidney had ureteral reflux. Serial ultrasounds documented the poor growth of all small kidneys. Thus, congenitally small kidneys with generally diminished DMSA uptake were highly associated with ureteral reflux and especially observed in boys.

Topics: Female; Follow-Up Studies; Humans; Incidence; Infant; Infant, Newborn; Kidney; Kidney Diseases; Male; Radiography; Radionuclide Imaging; Succimer; Ultrasonography; Urinary Tract Infections; Vesico-Ureteral Reflux

To determine up to what age children remain at risk of developing a new renal scar from a urinary tract infection.. Follow up study. Families of children who had normal ultrasound scans and scanning with dimercaptosuccinic acid (DMSA) after referral with a urinary tract infection when aged 3 (209) or 4 (220) were invited to bring the children for repeat scans 2-11 years later. A history of infections since the original scan was obtained for children not having a repeat scan.. Teaching hospital.. Children from three health districts in whom a normal scan had been obtained at age 3-4 years in 1985-1992 because of a urinary tract infection.. Frequency of new renal scars in each age group.. In each group, about 97% of children either had repeat scanning (over 80%) or were confidently believed by their general practitioner or parent not to have had another urinary infection. The rate of further infections since the original scan was similar in the 3 and 4 year old groups (48/176 (27%)) and 55/179 (31%)). Few children in either group known to have had further urinary infections did not have repeat scanning (3/209 (1.4%) and 4/220 (1.8%)). In the 3 year old group, 2.4% (5/209) had one or more new kidney scars at repeat scanning (one sided 95% confidence interval up to 5.0%), whereas none of the 4 year olds did (one sided 95% confidence interval up to 1.4%). The children who developed scars were all aged under 3.4 years when scanned originally.. Children with a urinary tract infection but unscarred kidneys after the third birthday have about a 1 in 40 risk of developing a scar subsequently, but after the fourth birthday the risk is either very low or zero. Thus the need for urinary surveillance is much reduced in a large number of children.

Topics: Adolescent; Child; Child, Preschool; Cicatrix; Follow-Up Studies; Humans; Kidney Diseases; Radionuclide Imaging; Risk Factors; Succimer; Urinary Tract Infections

Topics: Adolescent; Child; Child, Preschool; Cicatrix; Female; Humans; Infant; Kidney Diseases; Male; Radionuclide Imaging; Referral and Consultation; Succimer; Urinary Tract Infections

The early identification of renal cortical scarring secondary to urinary reflux and/or renal infection is important in the management of patients with recurrent disease. Scintigraphic imaging of the renal cortex using 99Tcm-dimercaptosuccinic acid (DMSA) is often considered the standard method for the diagnosis of renal scars in both adults and children. Consistent reporting of 99Tcm-DMSA is nevertheless essential in ensuring that the clinician can act on the data reported. In this study, seven experienced observers were asked to report, independently, 99Tcm-DMSA data sets from 32 patients. The observers were asked to note the presence of a space occupying lesion or of a renal cortical scar(s) and to conclude if the kidney was normal or abnormal. There was marked variation in the number of renal cortical scars reported, the total number of scars seen and whether or not the kidney was normal or abnormal. After peer review of all data, consensus and referenced criteria were arrived at for a reanalysis of data. All scans were reread by the observers. There was some improvement in the concordant reporting of kidneys with renal scars (51 vs 61%) and whether or not the kidney was normal or abnormal (53 vs 63%). However, this was not statistically significant (at a level of P < 0.05). This study demonstrated significant inter-observer variation regarding the reporting of 99Tcm-DMSA studies. A consensus with agreed guidelines for data interpretation did not significantly affect this apparent lack of consistency of reporting.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Cicatrix; Female; Humans; Infant; Kidney; Kidney Cortex; Kidney Diseases; Male; Middle Aged; Observer Variation; Organotechnetium Compounds; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid

The aim of this study was to determine whether age, C-reactive protein (CRP), body temperature, or results of voiding cystourethrography at diagnosis of first-time symptomatic urinary tract infection could predict the risk of renal damage as evaluated by dimercaptosuccinic acid (DMSA) scintigraphy performed 1 year after the infection.. The study included 157 children (median age, 0.4 year, range, 5 days to 5.8 years) with first-time symptomatic urinary tract infection. In children 1 year of age or older, a body temperature of 38.5 degrees C or higher was necessary for inclusion. CRP and body temperature were measured at the time of infection, and voiding cystourethrography was performed shortly thereafter. DMSA scintigraphy was performed 1 year later in all children.. After 1 year, 59 (38%) of the 157 children had renal damage as evaluated by DMSA scintigraphy, and of these, 28 (47%) had reflux. There was a positive correlation between renal damage and CRP, body temperature, and reflux. Children with high levels of CRP, high fever, and dilating reflux had a risk of renal damage up to 10 times higher than children with normal or slightly elevated CRP levels, no or mild fever, and no reflux.. CRP concentration and body temperature at the index infection, in combination with the results of voiding cystourethrography, are useful in classifying children at high and low risk of scintigraphic renal damage 1 year after urinary tract infection.

Topics: Age Factors; Body Temperature; C-Reactive Protein; Child; Child, Preschool; Follow-Up Studies; Humans; Infant; Infant, Newborn; Kidney; Kidney Diseases; Logistic Models; Organotechnetium Compounds; Prospective Studies; Radiography; Radionuclide Imaging; Risk Factors; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Time Factors; Urinary Bladder; Urinary Tract Infections

Absolute 99Tcm-dimercaptosuccinic acid (DMSA) uptake was measured in 160 children ranging in age from 3 months to 15 years. In total, 108 pairs of kidneys were normal and the mean uptake for the left and right kidneys was 24.0 and 23.4%, respectively. The mean summed uptake for the left and right kidneys was 47.3%. A method of calculation based on the geometric mean of the anterior and posterior views was used to allow for radiation attenuation. DMSA uptake did not vary significantly with the age of the child. The value of the method in the assessment of abnormal kidneys is presented. The effect of using a supine or prone position for the anterior view was also investigated.

Topics: Adolescent; Age Factors; Child; Child, Preschool; Humans; Infant; Kidney; Kidney Diseases; Organotechnetium Compounds; Prone Position; Reference Values; Regression Analysis; Succimer; Supine Position; Technetium Tc 99m Dimercaptosuccinic Acid; Tomography, Emission-Computed

17 children from 18 months to 16 years old were treated by ESWL for calculi of the upper urinary tract using a Sonolith 3000 lithotriptor. 31 calculi (5 to 60 mm) have been treated on 16 renal units and 3 pelvic ureters. The renal parenchyma of all treated kidneys was considered normal on preoperative ultrasound and IVU; 8 patients had a preoperative DMSA. The treatment required 1 to 4 sessions delivering 400 to 3000 shocks per session and 400 to 6000 shocks per treatment at 14 kV. Within three months post treatment, 14 patients (88.23%) were stone free and 3 patients had residual fragments (2 needed further surgical extraction). With a follow up of three months to five years, all patients have a normal blood pressure, serum creatinine and sterile urine. In no instance, IVU or ultrasound revealed a lesion imputable to ESWL. Seven patients had a DMSA six months or more after the last session; 4 of these were normal but the three other patients had a loss of function and an heterogeneous fixation on the treated side. These preliminary results confirm that ESWL is efficient for upper urinary tract calculi destruction in children. However ESWL seems to be susceptible to induce parenchymal damage, detected by DMSA, whose incidence and long term effects particularly on blood pressure need further evaluation.

Topics: Adolescent; Child; Child, Preschool; Follow-Up Studies; Humans; Infant; Kidney Diseases; Lithotripsy; Organotechnetium Compounds; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Treatment Outcome; Urinary Calculi

To determine whether untreated asymptomatic bacteriuria is associated with renal scarring in children with neuropathic bladders managed with clean intermittent catheterization (CIC).. Retrospective study of 207 patients aged 1 to 30 years (mean 11.9 +/- 5.5 years) treated with CIC for a mean duration of 6.6 +/- 3.9 years by the spina bifida program at Children's National Medical Center. All patients were examined for renal scarring with dimercaptosuccinic acid (DMSA) renal scans. Catheterized urine cultures were obtained annually, but bacteriuria ( > 10,000 colony-forming units of a single organism per milliliter) was treated only if the patients had symptoms or if vesicoureteral reflux (VUR) was present.. Of 207 children, 176 (85%) had one or more episodes of untreated asymptomatic bacteriuria and 72 (35%) had one or more febrile episodes associated with positive urine culture results. Biannual DMSA scans detected 54 new scarring episodes in 42 patients. Of newly recognized scars, 55% were preceded within 1 year by a febrile infection, 26% were detected in patients with VUR and asymptomatic bacteriuria, and 19% were detected in new patients during their initial examination. Univariate analysis revealed that new scarring was present in 35 of 176 patients with asymptomatic bacteriuria compared with 7 of 31 patients without (p = 809). Logistic regression analysis revealed that factors associated with scarring were febrile infections (adjusted odds ratio [OR] = 30.6, 95% confidence interval [CI] = 9.8 to 95.8), age more than 20 years (OR = 4.3, CI = 1.01 to 18.5), the presence of bladder trabeculation (OR = 2.7, CI = 1.0 to 7.6), and VUR (OR = 58.8, CI = 6.3 to 547.3), but asymptomatic bacteriuria was not associated with scarring.. In the absence of VUR, asymptomatic bacteriuria in patients undergoing CIC is not a significant risk factor for scarring and does not require antibiotic therapy.

Topics: Adult; Bacteriuria; Child; Child, Preschool; Chronic Disease; Cicatrix; Female; Humans; Infant; Kidney; Kidney Diseases; Logistic Models; Male; Organotechnetium Compounds; Radionuclide Imaging; Retrospective Studies; Risk Factors; Self Care; Spinal Dysraphism; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Treatment Outcome; Urinary Bladder, Neurogenic; Urinary Catheterization

A total of 282 renal scintigrams with Tc-99m DMSA in 238 children ranging in age from 10 days to 13 years performed during a 3-year period were reviewed. The authors present 94 kidneys in 85 children in whom no sign of pathology was demonstrated clinically, either by ultrasound or intravenous urography, or by micturating urethrocystography. By exploring homogeneity or heterogeneity of tracer distribution, kidney length, and background level, the authors were able to identify a "normal" pattern of tracer distribution according to age. They found that the average kidney length was 56 mm at birth, growing 1 mm per month during the first year of life, and 4 mm per year thereafter, until puberty. Average background activity was 14% of the average kidney activity at birth which decreased to approximately 6% during the first year of life, with no further decrease thereafter.

Topics: Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Kidney; Kidney Diseases; Male; Organotechnetium Compounds; Radionuclide Imaging; Reference Values; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Ultrasonography

Planar renal scintigraphy with Tc-99m DMSA has become established as a standard diagnostic test to determine if a kidney has been scarred by infection. It has been suggested that high resolution SPECT may improve the sensitivity of detection of renal scars. To determine if it is possible to produce good quality renal SPECT with a short acquisition time, 10 adults were examined with a new multi-detector gamma camera using 8 minute, 16 minute, and 32 minute acquisitions. The number of defects seen (N = 16) with an 8 minute acquisition was not significantly different from the defects (N = 15) seen using a 16 minute and a 32 minute acquisition. In adults when imaging with a multi-detector gamma camera there was no clinical advantage in using an acquisition of longer than 8 minutes.

Topics: Adolescent; Adult; Female; Gamma Cameras; Humans; Kidney; Kidney Diseases; Male; Middle Aged; Organotechnetium Compounds; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Tomography, Emission-Computed, Single-Photon; Urinary Tract Infections

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

Sixty-eight patients (135 kidneys) with varied renal pathology were evaluated with 99Tcm-dimercaptosuccinic acid (DMSA) single photon emission tomography (SPET) to determine whether it is possible to detect more renal abnormalities and to reduce the number of false-positives due to anatomical variants when compared with planar imaging. The patients ranged in age from 1 to 78 years and their pathologies included urinary tract infection (n = 50), space occupying lesions (n = 5), calculi (n = 4), hypertension (n = 4) and others (n = 5). Planar scans were performed 3 h after the injection of 80 MBq of 99Tcm-DMSA and a 64 x 20 s acquisition over 360 degrees was used for SPET. High-resolution collimation was used for both. Slices were displayed as transaxial, coronal and sagittal and/or oblique sagittal in the plane of the kidney. Three-dimensional (3D) images were formed by volume rendering. Each kidney was divided into three regions and each region scored separately for the presence of an abnormality. Planar scans were reviewed alone and then in conjunction with SPET and 3D images. Planar imaging detected 95 abnormal regions compared with 103 using SPET. SPET reduced the number of equivocal regions in 8 (12%) patients. The diagnosis was altered by SPET in 17 (4%) regions in 14 (21%) patients. SPET and 3D 99Tcm-DMSA allow more abnormalities to be detected but also allow more specific definition of apparent abnormalities on planar imaging.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Female; Humans; Image Processing, Computer-Assisted; Infant; Kidney; Kidney Diseases; Male; Middle Aged; Organotechnetium Compounds; Radioisotope Renography; Sensitivity and Specificity; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Tomography, Emission-Computed, Single-Photon; Urinary Tract Infections

Neonatal renal venous thrombosis (NRVT) is a serious complication of newborns. Ultrasound is most useful in detecting NRVT. However, there is no detailed description of the evolution of ultrasound finding in NRVT. Here we report a patient with NRVT with complete ultrasound follow-up. Perivascular streaks were first seen at 3 days of age with a diffusely enlarged and echogenic right kidney. Echolucency then gradually appeared over the medulla area with shrinking renal size. Concomitant loss of renal function was evidenced by dimercaptosuccinic acid scan. The kidney became contracted at the age of 1 year. Since the pathognomonic perivascular streaks were present for only a few days, early ultrasound scanning should be performed for every newborn suspected of having NRVT.

Topics: Humans; Infant, Newborn; Kidney Diseases; Kidney Function Tests; Male; Organotechnetium Compounds; Radionuclide Imaging; Renal Veins; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Thrombosis; Ultrasonography

We compared the efficiency of the IVP, the ultrasound and the DMSA scan in the detection of pyelonephritic lesions during the evaluation of 165 kidneys in 83 children, aged up to 14 years, with vesicoureteric reflux. Our study showed an efficiency of 60.20% for the IVP, 29.60% for the ultrasound and 96.90% for the DMSA scan. These results clearly show that the best imaging method for detecting renal scars is the DMSA scan, followed by IVP and ultrasound.

Topics: Adolescent; Age Factors; Child; Evaluation Studies as Topic; Humans; Kidney Diseases; Organotechnetium Compounds; Radionuclide Imaging; Sensitivity and Specificity; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Ultrasonography; Urography; Vesico-Ureteral Reflux

To assess the value of an ultrasound examination in children with a proven urinary tract infection.. The results of renal ultrasound and 99mTc-dimercapto-succinic acid (DMSA) studies were compared in 112 children with a first documented symptomatic Escherichia coli urinary tract infection.. Ultrasound was particularly effective in detecting the presence of obstruction, renal swelling and parenchymal change consistent with acute pyelonephritis. However, ultrasound failed to detect half of the kidneys with photon deficient areas on 99mTc DMSA scan and was unreliable in detecting the presence of scarring.. An ultrasound examination alone should not be relied on in the child with an acute urinary tract infection.

Topics: Adolescent; Child; Child, Preschool; Escherichia coli Infections; Female; Humans; Infant; Kidney Diseases; Male; Organotechnetium Compounds; Prospective Studies; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Ultrasonography; Ureteral Obstruction; Urinary Tract Infections

Quantitative 99mTc-dimercaptosuccinic acid (99mTc-DMSA) renal scintigraphy was used to asses ifosfamide-induced changes in renal function in 11 children who received chemotherapy for various malignancies. Serial measurements of absolute 99mTc-DMSA renal uptake, calculated on conjugated views, were performed during and after chemotherapy. Data of 37 studies obtained before and at different cumulative dose levels of ifosfamide were analysed in relation to clinical and biochemical parameters. A highly significant relationship between 99mTc-DMSA uptake and cumulative ifosfamide dose was found (P < 0.001). The most frequently observed abnormal pattern on scintigraphic images was decreased kidney uptake together with increased accumulation in bladder. 99mTc-DMSA uptake was more consistent than beta 2-microglobulin values in urine and more sensitive than quantitative hyperaminoaciduria and tubular resorption of phosphate for the detection of ifosfamide-induced tubular dysfunction. 99mTc-DMSA uptake was decreased in both patients with and patients without clinical toxicity. Persistently reduced 99mTc-DMSA uptake was observed in four patients during follow-up; in one of them, who was asymptomatic after ifosfamide therapy, sudden onset of Fanconi syndrome was observed when he was retreated with carboplatin 1 year later. It is concluded that 99mTc-DMSA renal scintigraphy is a suitable method to assess progressive ifosfamide-induced tubular injury whereas scintigraphic imaging is helpful for interpreting renal uptake changes. The test is able to detect subclinical injury and may potentially predict high risk at retreatment.

Topics: Antineoplastic Combined Chemotherapy Protocols; Child; Child, Preschool; Dose-Response Relationship, Drug; Female; Humans; Ifosfamide; Infant; Kidney Diseases; Kidney Tubules; Male; Neoplasms; Organotechnetium Compounds; Radioisotope Renography; Sensitivity and Specificity; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid

Dimercaptosuccinic acid (DMSA) renal scans were performed on 75 children (115 refluxing renal units) to determine the efficacy of routine scanning in patients with various grades of vesicoureteral reflux. Cystourethrography demonstrated grades I and II reflux in 75 renal units and grades III to V in 40. Of the patients 51 presented with febrile urinary tract infection and 24 were asymptomatic (patients presenting with nonfebrile urinary tract infections or those undergoing sibling screening). Renal ultrasounds were performed in 60 patients. All patients were initially managed with medical therapy and 19 (25%) ultimately underwent antireflux surgery. DMSA scans demonstrated scarring in 17 of 40 renal units (43%) of patients with high grade vesicoureteral reflux and 6 of 75 renal units (8%) of those with low grade reflux. Renal ultrasounds that were interpreted as normal always correlated to a normal DMSA scan in asymptomatic patients. In patients presenting with febrile urinary tract infections the correlation between ultrasound and DMSA scan was inconsistent. We advocate a tailored approach in the evaluation of patients with vesicoureteral reflux. Renal sonography may be sufficient in the assessment of renal scarring in asymptomatic patients with reflux and those with low grade reflux. Conversely, in patients with high grade vesicoureteral reflux, a history of febrile urinary tract infections and abnormal renal ultrasound DMSA renal scans appear to be most useful.

Topics: Child; Child, Preschool; Cicatrix; Female; Fever; Humans; Infant; Infant, Newborn; Kidney; Kidney Diseases; Male; Organotechnetium Compounds; Predictive Value of Tests; Radioisotope Renography; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Ultrasonography; Urinary Tract Infections; Vesico-Ureteral Reflux

The value of 99mTc-dimercaptosuccinic acid (DMSA) planar renal scintigraphy, DMSA single photon emission computed tomography (SPECT), and magnetic resonance imaging (MRI) in the assessment of renal injury related to vesicoureteral reflux (VUR) was examined in 60 kidneys of 32 pediatric patients (28 bilateral, 4 unilateral) with primary VUR. The results were: (1) detection of minor renal lesions was best with MRI, then DMSA-planar and DMSA-SPECT, and (2) in comparing the positive rate, DMSA-SPECT (85%) and MRI (83.3%) were superior to intravenous pyelography (55%) and DMSA-planar scintigraphy (65%). These results suggest that DMSA-SPECT or MRI may be more sensitive than DMSA-planar scintigraphy and intravenous pyelography in detecting renal injury related to VUR in pediatric patients.

Topics: Child; Child, Preschool; Female; Humans; Kidney; Kidney Diseases; Magnetic Resonance Imaging; Male; Sensitivity and Specificity; Succimer; Technetium; Tomography, Emission-Computed, Single-Photon; Urography; Vesico-Ureteral Reflux

The newly developed 99mTc-labeled renal imaging agent, mercaptoacetyltriglycine (MAG3), is a tubular secreted compound. It is expected the most suitable agent to measure renal function and image urinary tract because of the excellent imaging properties and availability of 99mTc and preferred biological qualities of radiohippurates. We examined 15 patients (8 males, 7 females, mean age 55 years old) with renal and urinary tract disease. After drinking 400 ml of water, 185, 370 or 555 MBq of 99mTc-MAG3 was injected with the supine position. Dynamic scans were acquired for 20 minutes on a large field of view gamma camera (ZLC-7500 Siemens Medical Inc.) linked to a computer system (Scintipac-2400 Shimadzu Co.) in a 64 x 64 matrix. Regions of interest (ROI) were placed around each kidney. Curves of 12 seconds frame rate were generated from all two ROIs over the 20 minutes study. The time to peak count (Tmax) and time from peak count to a half count (T1/2) were calculated from the curve data. 99mTc-DTPA renal imaging was examined to the same patients with the same method like 99mTc-MAG3. The renogram of 131I-orthoiodohippurate (OIH) was performed with probe method. The excellent quality of the renal image was obtained with 185-555 MBq of 99mTc-MAG3 compared with the same dose of 99mTc-DTPA respectively. The diagnostic value of 99mTc-MAG3 renal imaging was as well as 99mTc-DMSA renal imaging. The Tmax of 99mTc-MAG3 renogram was same value of that of both 99mTc-DTPA and 131I-OIH renogram. The T1/2 of 99mTc-MAG3 renogram was significantly lower than that of 99mTc-DTPA renogram. The T1/2 of 99mTc-MAG3 renogram was slightly higher that of 131I-OIH renogram. We conclude that the renal imaging of 99mTc-MAG3 was able to acquire the most excellent image and the proper renogram pattern as same as 131I-OIH renogram.

Topics: Adult; Aged; Female; Humans; Iodine Radioisotopes; Iodohippuric Acid; Kidney Diseases; Male; Middle Aged; Organotechnetium Compounds; Radioisotope Renography; Succimer; Technetium Tc 99m Mertiatide; Technetium Tc 99m Pentetate

An extensive study to compare planar and single photon emission computed tomographic (SPECT) 99Tcm-dimercaptosuccinic acid (DMSA) determination of differential kidney function (DKF) has been carried out. The study has demonstrated that it is possible to use SPECT differential kidney function in place of that obtained using planar scintigraphy. The SPECT DKF value correlated with the planar DKF value. Gradient shaded three-dimensional surface images, reoriented transaxial, sagittal and coronal slices were produced during the same processing method.

Topics: Adolescent; Adult; Child; Child, Preschool; Female; Humans; Infant; Kidney; Kidney Diseases; Male; Middle Aged; Organotechnetium Compounds; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Tomography, Emission-Computed, Single-Photon

Prenatal findings in infants who were postnatally found to have a unilaterally nonfunctioning cystic, dysplastic or absent kidney were evaluated to understand better the prenatal pathophysiology of these conditions. Of the 38 cases in which prenatal and postnatal renal imaging studies were done fetal renal conditions leading to postnatal dysplasia or absence included small echogenic kidneys in 3, typical multicystic dysplasia in 30, obstructive uropathy in 4 and perinephric urinoma in 1. Abnormalities were noted on postnatal imaging in 30% of the contralateral kidneys. Vesicoureteral reflux was the most commonly identified abnormality, occurring in 23% of the cases.

Topics: Female; Fetal Diseases; Humans; Infant; Infant, Newborn; Kidney; Kidney Diseases; Male; Organotechnetium Compounds; Pregnancy; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Ultrasonography, Prenatal

By using a radioimmunoassay specific for endothelin-1 (ET-1), we measured urinary excretion of ET-1-like immunoreactivity (LI) in 63 spot urine samples of 48 patients with primary vesicoureteral reflux (VUR). And also, urinary excretion of N-acetyl-beta-D-glucosaminidase (NAG), beta 2-microglobulin (beta-2-MG), microalbumin (Alb) and creatinine (Cr) were measured. There was no significant correlation in any of the pairs ET-1 and NAG, ET-1 and beta 2-MG, and ET-1 and Alb. Comparing the grade of reflux according to the International Classification with urinary ET-1, urinary ET-1/Cr levels in patients with grade 2, 3 and 4 VUR were higher than normal, and the ratio of more than normal urinary ET-1/Cr increased in proportion to the grade of reflux, but it conversely decreased in grade 5. In conclusion, urinary ET-1 may be an indicator of renal tubular injury in patients with primary VUR, and its meaning may be different from conventional urinary parameters.

Topics: Acetylglucosaminidase; Adolescent; Adult; Aged; Albuminuria; beta 2-Microglobulin; Biomarkers; Child; Child, Preschool; Chromium; Creatinine; Endothelins; Female; Humans; Infant; Kidney Diseases; Male; Middle Aged; Radioimmunoassay; Succimer; Vesico-Ureteral Reflux

Topics: Humans; Kidney; Kidney Diseases; Organotechnetium Compounds; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid

Sixteen symptom-free siblings of children with vesicoureteral reflux were found to have the condition and underwent renal scintigraphy with technetium 99m dimercaptosuccinic acid. Of these 16 children, 6 had scintigraphic evidence of renal damage. Screening for vesicoureteral reflux in siblings of children known to have the condition should therefore be carried out early in life; when reflux is present, an immediate assessment of the renal parenchyma should be made.

Topics: Child; Child, Preschool; Female; Humans; Infant; Kidney; Kidney Diseases; Male; Organotechnetium Compounds; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Vesico-Ureteral Reflux

The use of 99mTechnetium dimercaptosuccinic acid (99mTc DMSA) scanning for the early diagnosis of upper urinary tract infections has been preferred for a few years. In this research we investigated the use of 99mTc DMSA scanning in the localization of renal parenchymal involvement in urinary tract infection. Twenty-four children presenting with first acute urinary tract infection were studied. Investigations included physical examination, white blood cell count (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), antibody-coated bacteria (ACB) and early 99mTc DMSA scanning. 99mTc DMSA scanning was taken as the gold standard method in determining renal parenchymal inflammation. According to the 99mTc DMSA scanning the sensitivity of clinical findings was 57.14%, WBC 23.80%, ESR 33.33%, CRP 14.28% and ACB 71.42% in the localization of urinary tract infection. We propose early 99mTc DMSA scanning performed around the time of infection as a good technique for localization of the level of infection in the urinary tract.

Topics: Bacterial Infections; Child; Female; Humans; Kidney; Kidney Diseases; Male; Organotechnetium Compounds; Physical Examination; Predictive Value of Tests; Sensitivity and Specificity; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Tomography, Emission-Computed, Single-Photon; Urinary Tract Infections

Renal damage without scarring is a rare manifestation of reflux nephropathy, and is infrequently reported in the literature. A retrospective review of a large series of patients with urinary tract disorders at the hospital for Sick Children, Great Ormond Street, identified 12 patients with vesico-ureteric reflux (VUR) with no evidence of scarring but with renal damage as assessed using technetium 99m dimercaptosuccinic acid (99mTc-DMSA) scan. There were 9 simplex kidneys, the differential function was between 33% and 43% (mean 38%). On follow-up to date (mean 6.7 years) all kidneys show stable differential function with neither improvement nor deterioration. Only 8 children had a urinary tract infection. Renal damage without evidence of a focal scar associated with VUR may be a manifestation of growth arrest possibly due to glomerular damage. The sensitivity of 99mTc-DMSA may reveal the permanent nature of the renal damage.

Topics: Child; Child, Preschool; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Kidney; Kidney Diseases; Male; Organotechnetium Compounds; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Ultrasonography; Vesico-Ureteral Reflux

This study was designed to evaluate the occurrence and the type of proteinuria in 82 children with vesico-ureteric reflux (VUR) with or without renal scars. The urinary excretion of the high molecular weight protein albumin was taken as an index of glomerular alterations and the excretion of retinol-binding protein (RBP), beta 2-microglobulin and brush border antigens (BBA) (measured by monoclonal antibody-based enzyme-linked immunosorbent assay) was taken as an index of tubular alterations. All such markers were increased in children with VUR and were related to the degree of renal function. Patients showing reduced creatinine clearance had very high levels of albuminuria, microproteinuria and BBA, with all these variables reciprocally correlated. In children with normal renal function however, only microproteins (not albumin or BBA) were slightly increased, thus indicating an isolated tubular defect without involvement of the proximal segment of the tubule. However, microprotein excretion did not correlate with the grade of scarring (99mtechnetium-dimercaptosuccinic acid scan), both RBP and beta 2-microglobulin excretion being normal in 75% of children with radioisotopic signs of renal lesions but increased in 17% of children without scars. Therefore, tubular proteinuria identifies different groups of children with VUR but is not related to renal scarring. Prospective studies will define the usefulness of proteinuria as a reliable indicator of renal outcome.

Topics: Adolescent; Antigens, Surface; beta 2-Microglobulin; Child; Child, Preschool; Creatinine; Humans; Kidney Diseases; Kidney Tubules, Proximal; Microvilli; Organotechnetium Compounds; Prospective Studies; Proteinuria; Radiography; Retinol-Binding Proteins; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Vesico-Ureteral Reflux

99mTechnetium dimercaptosuccinic acid (DMSA) scintigraphy is the imaging modality of choice for the detection of acute pyelonephritis and chronic renal scarring in children. Using the DMSA scan we prospectively evaluated renal scarring after reflux and nonreflux pyelonephritis in children. The study population consisted of 33 patients with acute pyelonephritis documented by a DMSA renal scan at infection. The children were evaluated for renal scarring with a followup DMSA scan 4 to 42 months (mean 10.7 months) after the acute infection. All new scarring on followup DMSA scans occurred at sites corresponding exactly to areas of acute inflammation on the initial DMSA scan. Therefore, only those kidneys with acute changes on the initial scan were subsequently analyzed. Of 38 kidneys new or progressive scarring developed in 16 (42%), including 6 of 15 (40%) with associated vesicoureteral reflux and 10 of 23 (43%) without demonstrable reflux. New renal scarring developed in 6 of the 7 kidneys (86%) associated with a neuropathic bladder or posterior urethral valves. In contrast, new scarring developed in only 10 of 31 kidneys (32%) associated with a normal bladder (p = 0.028). Excluding the kidneys associated with a neuropathic bladder or posterior urethral valves, new renal scarring developed in 3 of 12 (25%) with primary reflux, compared with 7 of 19 (37%) without vesicoureteral reflux. Except for the white blood count and the species of infecting bacteria, no other statistically significant differences could be found between those cases in which scars did or did not develop. We conclude that acquired renal scarring only occurs at sites corresponding to previous areas of acute pyelonephritis, the acute parenchymal inflammatory changes of acute pyelonephritis are reversible and do not lead to new renal scarring in the majority of cases, and once acute pyelonephritis has occurred ultimate renal scarring is independent of the presence or absence of vesicoureteral reflux.

Topics: Adolescent; Child; Child, Preschool; Cicatrix; Female; Humans; Infant; Kidney Diseases; Male; Organotechnetium Compounds; Prospective Studies; Pyelonephritis; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Vesico-Ureteral Reflux

Male Sprague-Dawley rats were exposed to high-dose (0.5%) lead acetate for periods ranging from 1 to 9 months; then lead exposure was discontinued, and animals were sacrificed after 12 months. Controls were pair-fed. Two additional groups of low-dose (0.01%) and high-dose (0.5%) rats were exposed to lead for 6 months, then lead was discontinued and the rats were treated with three 5-day courses of 0.5% DMSA (dimercaptosuccinic acid) over the next 6 months. Controls were rats exposed to lead for 6 months, then removed from exposure for 6 months without receiving DMSA. Low-dose lead-treated rats showed no significant pathological changes with or without DMSA treatment, but exhibited a significant increase in GFR after DMSA. High-dose lead-treated animals showed no functional or pathological changes when lead exposure was discontinued after 1 month. However, when duration of exposure was 6 or 9 months, GFR was decreased and serum creatinine and urea nitrogen were increased as compared to controls. Tubulointerstitial disease was severe. Administration of DMSA resulted in an improvement in GFR and a decrease in albuminuria, together with a reduction in size and number of nuclear inclusion bodies in proximal tubules. However, tubulointerstitial scarring was only minimally reduced. It may be concluded that, except for brief initial exposure, discontinuation of high-dose lead exposure fails to reverse lead-induced renal damage. Treatment with the chelator, DMSA, improves renal function but has less effect on pathological alterations. As GFR improved after DMSA treatment in both low-dose and high-dose lead-treated rats, irrespective of the degree of pathological alterations, it may be concluded that the DMSA effect is most likely mediated by hemodynamic changes.

Topics: Acetylglucosaminidase; Albuminuria; Animals; Blood Urea Nitrogen; Creatinine; Erythrocyte Membrane; Glomerular Filtration Rate; Glutathione Transferase; Hematocrit; Kidney; Kidney Diseases; Lead; Lead Poisoning; Male; Rats; Rats, Inbred Strains; Silicon; Sodium-Potassium-Exchanging ATPase; Succimer

In clinical practice, determining which patients with urinary tract infection have upper urinary tract involvement is difficult yet important for proper management. This report indicates that the 99mtechnetium dimercaptosuccinic acid (DMSA) scan is a useful test in making this determination.

Topics: Adolescent; Bacterial Infections; Child; Child, Preschool; Female; Humans; Infant; Kidney; Kidney Diseases; Male; Organotechnetium Compounds; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections

The properties of 99mTc-mercaptoacetyltriglycine (MAG3), a new radiopharmaceutic for dynamic renal scintigraphy, were assessed in a series of 138 patients with different diseases of the uropoietic system. The physiological values of renographic curves were determined as well as the characteristics of MAG3 excretion, which closely resembled the values for 131I-OIH. On comparing the values of separate MAG3 clearance with standard radiopharmaceutics in 26 subjects examined, very good correlation coefficients (r) were obtained: 0.98, 0.96, and 0.92 for 131I-OIH, 99mTc-DMSA, and 99mTc-DTPA, respectively. Global MAG3 clearance reached 0.64 of the OIH value. The higher quality of scinfigraphic imaging than seen with the substances used so far, the favorable pharmacokinetic properties and the low radiation load (H(E) = 0.51 mSv in adults) of MAG3 determine the indication spheres in which it can best be used to advantage. Of the radiopharmaceutics used to date, MAG3 yields the best results. It can well substitute 123I-OIH, which is not readily available in our conditions, and can thus be expected to be widely used in clinical practice.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Female; Humans; Infant; Iodine Radioisotopes; Iodohippuric Acid; Kidney; Kidney Diseases; Male; Middle Aged; Organotechnetium Compounds; Radioisotope Renography; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Mertiatide; Technetium Tc 99m Pentetate

Static isotope imaging with 99mtechnetium-dimercaptosuccinic acid was performed at a mean age of 34 days in 32 children (50 kidneys) whose vesicoureteral reflux had been identified as a result of prenatal ultrasound scanning. Three patterns of isotope uptake were observed: 1) noninfected primary vesicoureteral reflux (15 children, 24 kidneys), 2) noninfected secondary (obstructed) vesicoureteral reflux (9 patients, 11 kidneys) and 3) infected primary reflux (8 infants, 15 kidneys). In 20 pattern 1 kidneys (83%) renal morphology and differential isotope were normal. In the 4 kidneys (17%) that showed evidence of impaired function this took the form of global parenchymal loss, that is small kidneys rather than focal scarring. In pattern 2 the combination of fetal vesicoureteral reflux and obstruction was a potent cause of renal damage with total or near total loss of function in 7 of 9 refluxing units associated with posterior urethral valves and in 2 kidneys with secondary ureteropelvic junction obstruction. Appearances of focal scarring were confined in pattern 3 and were found in 4 kidneys (27%). This overall incidence of detectable renal damage was lower than expected. Even when infection occurs, prenatal diagnosis may lessen the risk of scarring by enabling treatment to be instituted promptly. The findings suggest that uncomplicated primary vesicoureteral reflux is a relatively benign insult to the fetal kidney and that reflux nephropathy found in children presenting clinically is the result of infected vesicoureteral reflux in postnatal life. Any comparison of published studies will prove difficult until there is a more standardized approach to imaging technique and patient selection.

Topics: Female; Humans; Infant; Kidney Diseases; Male; Organotechnetium Compounds; Pregnancy; Radioisotope Renography; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Ultrasonography, Prenatal; Urinary Tract Infections; Vesico-Ureteral Reflux

A prospective study examining the incidence of dimercaptosuccinic acid (DMSA) abnormalities in children at the time of acute urinary tract infection, the progression of these abnormalities following treatment and their correlation with the presence of vesicoureteral reflux is reported. DMSA scans performed within 72 hours of presentation in 65 previously healthy children with acute urinary tract infection were abnormal in 34 (52%). The scan appearances of 30 of 36 (83%) initially abnormal kidneys improved or became normal on the repeat DMSA study performed at 3 to 6 months after the acute urinary tract infection. A cystogram demonstrated significant vesicoureteral reflux in 11 of 45 cases (24%). Of these 11 cases 10 had abnormal DMSA studies and 1 had dilated upper tracts on ultrasound. Several conclusions may be drawn from our study. The incidence of DMSA abnormalities at the time of acute urinary tract infection is high but these abnormalities tend to resolve with time. An abnormal DMSA study at the time of urinary tract infection identifies most children with significant vesicoureteral reflux, and in our series a combination of ultrasound and DMSA identified all cases. This study may have major implications for the clinical investigation of children with urinary tract infection.

Topics: Acute Disease; Child, Preschool; Female; Follow-Up Studies; Humans; Infant; Kidney Diseases; Male; Prospective Studies; Radiography; Radionuclide Imaging; Succimer; Urinary Tract Infections; Vesico-Ureteral Reflux

Topics: Child; Cicatrix; Humans; Kidney; Kidney Diseases; Radiography; Succimer

The presence of focal renal damage dictates different management of a child with urinary tract infection (UTI) compared with children who have normal kidneys. Technetium-99m-dimercaptosuccinic (DMSA) has a high sensitivity in the detection of a focal defect, and allows estimation of differential function. The introduction of 99mTc-MAG3 with high renal extraction suggests that this may be useful in children with UTI but its role remains speculative. Fifty-nine children with previous UTI underwent both 99mTc-DMSA and MAG3 within 4 wk of each other. Differential function and assessment of the images were undertaken. There is close correlation (R2 = 0.97) between the differential function. Analysis of the 99mTc-DMSA and functional MAG3 images showed that the functional image had a specificity of 88% and a sensitivity of 88% in the detection of a focal parenchymal defect. Technetium-99m-MAG3 in the clinical setting of a child with UTl allows accurate assessment of differential function and a high probability of detecting a focal renal abnormality.

Topics: Adolescent; Child; Child, Preschool; Female; Humans; Infant; Kidney Diseases; Male; Organotechnetium Compounds; Radionuclide Imaging; Sensitivity and Specificity; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Mertiatide

The use of 99Tcm-mercapto acetyl triglycine (99Tcm-MAG3), a new hippuran substitute, has been reported widely in adults but not in children. Our experience of its use in 100 infants and children for renography and indirect micturating cystography (IMC) is reported. The average age was 5.6 years. 65 patients completed IMC studies and nine patients had 99Tcm-dimercaptosuccinic acid (99Tcm-DMSA) scans performed on the same day. The majority of patients were referred for the investigation of urinary tract infection. 32 kidneys were found to be scarred on 99Tcm-MAG3 scans, 17 kidneys and ureters refluxed on IMC and 14 kidneys were obstructed. The results of 99Tcm-MAG3 scans were compared with those of other urinary tract investigations including ultrasound, micturating cystography (MCUG), intravenous urography (IVU) and 99Tcm-DMSA scintigraphy. No kidney which was scarred had a normal 99Tcm-MAG3 scan. All significant degrees of dilatation or obstruction on IVU or ultrasound were also detected by 99Tcm-MAG3. 99Tcm-MAG3 gave more information than any other single imaging modality and we believe it represents an ideal initial screening test in the investigation of urinary tract infection in older toilet-trained children.

Topics: Adolescent; Child; Child, Preschool; Cicatrix; Humans; Infant; Infant, Newborn; Kidney; Kidney Diseases; Kidney Pelvis; Organotechnetium Compounds; Radionuclide Imaging; Sensitivity and Specificity; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Mertiatide; Ureter; Ureteral Obstruction; Urinary Bladder; Urination; Urography

For evaluation of technetium-99m dimercaptosuccinic acid (99mTc-DMSA) renal uptake as an absolute renal function, 99mTc-DMSA uptake was compared with endogenous creatinine clearance (Ccr) in cisplatin-induced nephrotoxicity. At first, Male Wistar rats were given intraperitoneally 1.8 mg/kg/day of cisplatin for periods of 3, 5, 7 and 9 days. On the next day, 99mTc-DMSA uptake and Ccr were measured. Ccr of 5-day treated group was significantly lower than that of control (0.13 +/- 0.10 vs 0.34 +/- 0.05 ml/min/100 g; p less than 0.01) but 99mTc-DMSA uptake did not change. 99mTc-DMSA uptake of 7-day treated group was significantly lower than that of control (28.57 +/- 7.23 vs 39.84 +/- 2.23%; p less than 0.01). As the second experiment, cisplatin (3.6 mg/kg/day) was given intraperitoneally on the 1st, 2nd, 15th and 16th day. On the 5th, 8th, 11th, 15th, 20th, 23rd, 26th and 30th day, the same measurements were done as the first one. Ccr was lower in cisplatin treated rats on the 5th day than that in control (0.10 +/- 0.03 vs 0.34 +/- 0.05 ml/min/100 g; p less than 0.01), thereafter tended to be recovered to the control level. On the other hand, 99mTc-DMSA uptake was lower than that of control on the 8th, 11th and 15th day (32.40 +/- 3.86, 32.56 +/- 1.19, 35.21 +/- 2.97 vs 39.84 +/- 2.23%, respectively; p less than 0.01). The discrepancy between 99mTc-DMSA uptake and Ccr was observed in the cisplatin-induced nephrotoxicity. 99mTc-DMSA uptake was suggested to be a reliable indicator of a renal function in a different way from Ccr.

Topics: Animals; Cisplatin; Creatinine; Kidney; Kidney Diseases; Kidney Function Tests; Male; Organotechnetium Compounds; Radioisotope Renography; Rats; Rats, Inbred Strains; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid

For evaluation of technetium-99m dimercaptosuccinic acid (99mTc-DMSA) renal uptake as an absolute renal function, 99mTc-DMSA uptake was compared with endogenous creatinine clearance (Ccr) in gentamicin-induced nephrotoxicity. Gentamicin (40 mg/kg/day) was given subcutaneously to male Wistar rats for periods of 3, 6, 9 and 12 days. On the next day, the renography was performed 2 hours following intravenous injection of 99mTc-DMSA and Ccr was measured. On the 7th day, 99mTc-DMSA uptake was significantly lower in the treated rats than that in control (32.27 +/- 0.92 vs 39.84 +/- 2.24%; p less than 0.01), but Ccr did not change (0.37 +/- 0.02 vs 0.34 +/- 0.05 ml/min/100 g; NS). On the 1st, 2nd, 4th and 8th day after single subcutaneous injection of 80 mg of gentamicin, 99mTc-DMSA uptake was measured and the histological examination was done. On the 4th day, 99mTc-DMSA uptake was significantly lower than that on the 1st day (32.32 +/- 3.00 vs 38.91 +/- 1.95%; p less than 0.01) and microscopic examinations revealed that eosinophilic granular degenerations were evident in the renal cortex. The present study suggests that 99mTc-DMSA uptake reduces earlier than Ccr in gentamicin-induced nephrotoxicity and 99mTc-DMSA uptake is a reliable indicator in the evaluation of a renal function in drug-induced nephrotoxicity.

Topics: Animals; Creatinine; Gentamicins; Kidney; Kidney Diseases; Kidney Function Tests; Organotechnetium Compounds; Radioisotope Renography; Rats; Rats, Inbred Strains; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid

Voiding cystourethrography (VCU) of 407 children with vesicoureteral reflux (VUR) at our hospital during 1969-1990 was reviewed and 7 cases (8 ureters) of intrarenal reflux (IRR) were found. All the children were male and had had an episode of febrile urinary infection under one year of age. One child had a left flank mass, which was later proven a urinoma. VUR was moderate (grade III) in 3 and massive (grade IV and V) in 5. VUR was estimated as primary in one child and as secondary in 6 (anterior urethral ring 2, posterior urethral valve 2, neurogenic bladder 2). IRR was localized to the upper area in 3, to the lower area in 2, and to the whole kidney in 3. Sixty percent of those with IRR in the polar areas was associated with moderate VUR, whereas all of those in the whole kidney was with massive one. Renal scarring was assessed by excretory urography (IVP) and/or 99mTc-DMSA renoscintigraphy. Seven kidneys were evaluable; polar scars in 5, dwarf with polar scar in 1 and dwarf with poor function (suspected hypodysplasia) in 1. In 4 kidneys new scar formation was observed. It was noted, however, that IRR did not necessarily accompany renal scars of the corresponding areas and IRR to the whole kidney did not always lead to multiple scars in the whole kidney. The nature and problems of IRR, renal scars and 99mTc-DMSA renoscintigraphy were discussed. It was suggested that urinary infection played a greater part in renal scar formation.

Topics: Cicatrix; Humans; Infant; Infant, Newborn; Kidney; Kidney Diseases; Male; Organotechnetium Compounds; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections; Vesico-Ureteral Reflux

The relationship of vesicoureteric reflex (VUR) and renal scarring was studied in 94 children (188 kidneys) with proved urinary tract infection in a district general hospital. There were 61 girls and 33 boys, with nine girls and 17 boys aged less than 1 year, 31 girls and nine boys aged between 1 and 5 years, the remaining 28 children were over 5 years of age. All children had a micturating cystourethrogram and a 99mTc (technetium) dimercaptosuccinic acid (DMSA) scan. Forty two of the 188 kidneys were scarred and 70 of the kidneys had VUR. Only 37.1% of the kidneys with reflux were scarred but 61.9% of the scarred kidneys had VUR. In children of less than 1 year, 48% of kidneys with VUR were scarred whereas 70.6% of scarred kidneys had reflux. In children between 1 and 5 years of age only 36.4% of kidneys with VUR were scarred but 63.2% of scarred kidneys had VUR. There is good correlation between the detection of a scarred kidney on DMSA and the presence of vesicoureteric reflux. However the detection of reflux particularly in children over 1 year of age shows poor correlation with renal scarring. This suggests that the primary imaging in children over 1 year of age presenting with a urinary tract infection should be of the kidney: a cystogram should be performed only if the DMSA scan is abnormal.

Topics: Age Factors; Child; Child, Preschool; Cicatrix; Female; Humans; Infant; Infant, Newborn; Kidney; Kidney Diseases; Male; Radionuclide Imaging; Succimer; Urinary Tract Infections; Vesico-Ureteral Reflux

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

The protective effects of various chelating agents such as D-penicillamine (D-PEN), 2,3-dimercaptosuccinic acid (DMSA), 2,3-dimercaptopropane sulphonate (DMPS), and N-(2-mercapto-2-methylpropanoyl)-L-cysteine (bucillamine), on the renal damage induced by gold sodium thiomalate (AuTM) in rats were studied. Rats were injected i.v. with AuTM at doses of 0.026, 0.066, 0.132, and 0.198 mmol/kg. Urinary excretion of protein, aspartate aminotransferase (AST), and glucose in rats injected with AuTM significantly increased compared to the control levels within 1 day after the injection and thereafter decreased nearly to the control levels at 3 or 7 days. Gold was excreted rapidly during the first day after AuTM injection and excreted gradually thereafter. The concentrations of gold in the kidney and liver at 1 or 7 days after AuTM administration were approximately dose dependent. Treatment with D-PEN, DMSA, DMPS, and bucillamine (1.2 mmol/kg) significantly prevented increases in the urinary excretion of protein, AST, and glucose and the BUN level after AuTM (0.026 mmol/kg) injection. The injection of the chelating agents after AuTM administration showed that D-PEN, DMSA, and DMPS enhanced mainly the urinary excretion of gold and that bucillamine enhanced mainly the fecal excretion of the metal. These chelating agents significantly decreased the gold concentrations in the kidney and liver. The findings suggest that the chelating agents tested can ameliorate the renal damage induced by AuTM.

Topics: Animals; Chelating Agents; Cysteine; Glycosuria; Gold Sodium Thiomalate; Kidney Diseases; Male; Penicillamine; Rats; Rats, Inbred Strains; Succimer; Unithiol

Renoscintigraphy with 99mTc-DMCA with regard to a percentage of an RP uptake by the kidney was performed in 70 patients with uronephrological lesions before operation. A close relationship was established between a percentage of a 99mTc-DMCA uptake by the kidney on the 3rd hour after RP administration and values of the effective renal plasma flow, calculated on the basis of the results of renoscintigraphy with 131I-hippuran. Comparison of the 99mTc-DMCA uptake percentage values on the 3rd and 24th hours in patients with marked lesions of renal tubular functions has shown a high degree of correlation, permitting the recommendation of quantitative renoscintigraphy on the 3rd hour. Analysis of the specific percentage of the RP uptake, calculated for 1 cm2 of the visualized renal parenchyma, makes it possible to increase on the average by 29% the detection of renal function in uronephrological patients.

Topics: Adult; Humans; Hypertension; Iodohippuric Acid; Kidney Diseases; Kidney Tubules; Organotechnetium Compounds; Radioisotope Renography; Renal Circulation; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid

Using the established piglet model, renal scars were produced by a combination of vesicoureteric reflux and urinary infection. The presence and extent of scarring, as determined by postmortem examination, was compared with that detected by technetium 99m dimercaptosuccinic acid (DMSA) scans performed before sacrifice. Sixty female piglets (62 refluxing units) were studied. Overall the sensitivity (true-positive/(true-positive + false-negative)) of DMSA scanning in detecting macroscopic scarring was 85% and the specificity (true-negative/(true-negative + false-positive)) was 97%. There were five false-negatives, four of which were in kidneys with minor scarring and one in which there was major scarring. There were three false-positives. We conclude that DMSA scanning has a high specificity and sensitivity in detecting renal scars in female piglets, and suggest it is the preferred method for detecting renal scars in clinical practice.

Topics: Animals; Escherichia coli Infections; False Negative Reactions; False Positive Reactions; Female; Kidney Diseases; Organotechnetium Compounds; Predictive Value of Tests; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Swine; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections; Vesico-Ureteral Reflux

A retrospective comparison of 99Tcm dimercaptosuccinic acid (DMSA) scans and intravenous urograms (IVUs) was performed on a large, unselected paediatric population to assess critically the relative merits of these two techniques. A total of 205 children were studied, providing 388 kidneys for comparison. The studies agreed in 81%, both being normal in 39%, and both abnormal in 42%. In 28 kidneys (7%), the IVU was abnormal when the 99Tcm DMSA was normal. There was a collecting system abnormality in 27 kidneys, but 10 kidneys also showed a parenchymal abnormality. In all these the parenchymal abnormality was global thinning on the IVU, and the contralateral kidney was small. In 40 kidneys (10%) the 99Tcm DMSA was abnormal when the IVU was normal: the abnormalities demonstrated were predominantly focal defects. After excluding IVUs of poor diagnostic quality, only 14 kidneys (3.6%) showed this disparity. The important clinical subgroups are infection, with or without reflux (27 kidneys), hypertension (4) and neonates with poor renal function (2). The one false positive 99Tcm DMSA was a result of an anatomical variant. Global thinning in a "normal" kidney on a 99Tcm DMSA scan may be overlooked when the contralateral kidney is poorly functioning and small.

Topics: Adolescent; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Kidney; Kidney Diseases; Male; Organotechnetium Compounds; Radionuclide Imaging; Retrospective Studies; Succimer; Sulfhydryl Compounds; Technetium Tc 99m Dimercaptosuccinic Acid; Urography

A comparative study of the renal uptake rate of 99mTc-dimercaptosuccinic acid (DMSA) was performed using a phantom study and clinical data from 100 patients (200 kidneys) with a variety of renal diseases. The measurement methods for renal uptake rate studied here include a posterior-view method, a conjugate-view method, and a method using single photon emission computed tomography (SPECT). The renal uptake rates obtained by the posterior-view method significantly (P less than 0.001) depended on kidney depth correction. With the SPECT method, the cut-off level for delineating the kidney was changed according to the background count ratio using the results of the phantom study. The renal uptake rates obtained by the SPECT method correlated significantly (P less than 0.001) with those obtained by other methods, and there were no significant differences as compared with those obtained by the conjugate-view method. An analysis of error with the above methods indicated that the error relating to the sensitivity to body thickness was smallest for the SPECT method and greatest for the posterior-view method. In terms of measurement of renal uptake rate only, the conjugate-view method is considered the most useful because it needs no kidney depth correction and requires very little additional effort or examination time.

Topics: Female; Humans; Kidney; Kidney Diseases; Male; Middle Aged; Models, Structural; Organotechnetium Compounds; Succimer; Sulfhydryl Compounds; Technetium Tc 99m Dimercaptosuccinic Acid; Tomography, Emission-Computed, Single-Photon

Topics: Acute Disease; Child, Preschool; Cicatrix; Humans; Infant; Infant, Newborn; Kidney Diseases; Organotechnetium Compounds; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections

Topics: Child; Child, Preschool; Cicatrix; Humans; Kidney; Kidney Diseases; Organotechnetium Compounds; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Urography; Vesico-Ureteral Reflux

Topics: Age Factors; Cicatrix; Humans; Infant; Infant, Newborn; Kidney Diseases; Organotechnetium Compounds; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections

To calculate renal uptake of 99mTc-dimercaptosuccinic acid (DMSA) more accurately using single photon emission computed tomography (SPECT), it is necessary to estimate values of threshold level, which corresponds to the ratio of kidney to background (BG ratio). Thus the phantom and clinical studies were conducted. Six kinds of renal phantoms of 80 to 339 ml, contained different radioactivity of 37 to 485 MBq were prepared. These phantoms were placed in a larger body phantom filled with 1 to 50% of radioactivity representing background. Clinical application of this method was also performed. Results were as follows. 1) A significant correlation between phantom volumes and estimated volumes obtained using threshold level based on BG ratio calculated on tomographic images was found (r = 0.99). 2) A significant correlation between total counts in estimated volumes and radioactivities in phantoms was recognized (r = 0.94). 3) Known radioactivity in phantoms and radioactivity in estimated volumes were highly related (r = 0.98). 4) Clinical application showed valuable results in patients with renal dysfunction. Thus, this method can calculate more accurate renal uptake of 99mTc-DMSA.

Topics: Adult; Aged; Aged, 80 and over; Humans; Kidney; Kidney Diseases; Male; Middle Aged; Models, Structural; Organotechnetium Compounds; Reference Values; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Tomography, Emission-Computed, Single-Photon

Topics: Child; Child, Preschool; Cicatrix; Female; Humans; Kidney Diseases; Organotechnetium Compounds; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections

Quantitative single photon emission computed tomography (SPECT) methodology based on calibration with kidney phantoms has been applied for the assessment of renal uptake of [99mTc]DMSA in 25 normals; 16 patients with a single normal kidney; 30 patients with unilateral nephropathy; and 17 patients with bilateral nephropathy. An excellent correlation (r = 0.99, s.e.e. = 152) was found between SPECT measured concentration and actual concentration in kidney phantoms. Kidney uptake at 6 hr after injection in normals was 20.0% +/- 4.6% for the left and 20.8% +/- 4.4% for the right. Patients with unilateral nephropathy had a statistically significant (p less than 0.001) low uptake in the diseased kidney (7.0% +/- 4.7%), but the contralateral kidney uptake did not differ from the normal group (20.0% +/- 7.0%). The method was especially useful in patients with bilateral nephropathy. Significantly (p less than 0.001) decreased uptake was found in both kidneys (5.1% +/- 3.4% for the left and 6.7% +/- 4.2% for the right). The total kidney uptake (right and left) in this group showed to be inversely correlated (r = 0.83) with serum creatinine. The uptake of [99mTc]DMSA in single normal kidney was higher (p less than 0.001) than in a normal kidney (34.7% +/- 11.9%), however, it was lower than the total absolute uptake (RT + LT = 41.5% +/- 8.8%) in the normal group. The results indicate that SPECT is a reliable and reproducible technique to quantitate absolute kidney uptake of [99mTc]DMSA.

Topics: Adolescent; Adult; Aged; Female; Humans; Kidney; Kidney Diseases; Male; Middle Aged; Organometallic Compounds; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Tomography, Emission-Computed

We compared the ability of excretory urography (without tomography) and 99mtechnetium-dimercapto-succinic acid renal scanning to detect renal scars in 32 children with primary vesicoureteral reflux. These children did not have hydronephrosis, renal failure or urinary tract obstruction. In all cases both studies were conducted within a 10-month period. The findings from both modalities were in agreement for 51 of the 64 renal units evaluated (80 per cent). Evaluation of the excretory urogram indicated 6 cases of diffuse and 2 of focal scarring that were not detected by evaluation of the renal scan. The sensitivity of excretory urography to detect renal scars was 84 per cent and the specificity was 83 per cent. The 99mtechnetium-dimercapto-succinic acid renal scan showed 5 cases of focal renal scarring not detected by excretory urography. The sensitivity of the renal scan to detect renal scars was 77 per cent and the specificity was 75 per cent. We conclude that neither study alone could effectively replace the other for the detection of renal scars, and recommend that both be included in the initial evaluation and followup of patients with renal scars.

Topics: Adolescent; Child; Child, Preschool; Cicatrix; Evaluation Studies as Topic; Female; Humans; Kidney; Kidney Diseases; Male; Organometallic Compounds; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Urography

Renal scarring in 271 kidneys of 172 children with primary vesicoureteral reflux (VUR) was evaluated by 99mTc-DMSA renoscintigraphy. 58% of refluxing kidneys were with renal scar by the initial DMSA renoscintigraphy. Only 52% of these kidneys showed good correlation between the findings on IVP and DMSA renoscintigram. Of the 144 refluxing kidneys with normal IVP, 41% had renal scarring on DMSA renoscintigram. DMSA renoscintigram revealed widespread renal scarring in 28% of kidneys with only calyceal clubbing and in 60% of those with segmental cortical thinning on IVP. It is realized that IVP was an in-sensitive method to evaluate renal scarring of refluxing kidneys and such kidneys with segmental renal scar on IVP accompanies more widespread scar on DMSA renoscintigram. These cases were allocated to 2 age groups, younger than 3 years and older than 4 years. In the former group less than 10% of kidneys with low grade VUR and about 40% with high grade UVR had widespread renal scarring. On the contrary, in the latter group severe renal scar was recognized in more than 20% of kidneys with low grade VUR and in about 60% with high grade UVR.

Topics: Adolescent; Age Factors; Child; Child, Preschool; Cicatrix; Female; Humans; Infant; Kidney; Kidney Diseases; Male; Organotechnetium Compounds; Radiography; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Vesico-Ureteral Reflux

We studied two different methods for the evaluation of differential renal function in a group of 100 patients with various kidney disorders whose effective renal plasma flow (ERPF) had been calculated previously by single 125I-orthoiodohippurate (OIH) injection and multiple blood sampling. Patients were divided into three groups according to their ERPF:ERPF is greater than or equal to 250 ml min-1; ERPF less than or equal to 100 ml min-1; and ERPF greater than 100 ml min-1 and less than 250 ml min-1. The two methods used to assess differential renal function were: first, relative 99Tcm-dimercaptosuccinic acid (DMSA) uptake calculated by normalized background and attenuation corrected cumulative counts in each kidney 24 h p.i.; and second, relative 99Tcm-mercaptoacetyl-triglycine (MAG3) uptake within 1 and 2 min p.i. calculated by normalized background and attenuation corrected counts on each renal area. The results obtained with each method correlated strongly with high significance (p less than 0.0001). In the right kidney, mean values obtained with 99Tcm-MAG3 tend to be higher than mean values obtained with 99Tcm-DMSA.

Topics: Adult; Aged; Humans; Kidney Diseases; Middle Aged; Oligopeptides; Organotechnetium Compounds; Radioisotope Renography; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Mertiatide

Topics: Child, Preschool; Female; Humans; Infant; Kidney; Kidney Diseases; Radionuclide Imaging; Succimer; Urography

A method of high frequency image filtration improving the quality of imaging, and more precise renometry with measurement of the total count and the level of RP kidney accumulation were used for raising the informative value of the results of renal scintigraphy with 99m Tc-DMSA. 54 patients with unilateral pyelonephritis, 46--with bilateral pyelonephritis, 15--with nephroptosis, and 10 healthy persons were examined. Informative values were calculated on the basis of the results of these investigations. The sensitivity of routine renometry was 0.88, its specificity--0.27 and precision--0.78; the same indices for routine static scintigraphy were 0.88; 0.4 and 0.84; for modified renal investigations--0.98; 0.77 and 0.96, respectively. The results of the investigations have shown that the use of scintigraphy with improved quality of kidney images in parallel with modified renometry raises the informative value of renal studies with 99m Tc-DMSA and precision of diagnosis of renal parenchymal lesions.

Topics: Algorithms; Chronic Disease; Diagnosis, Computer-Assisted; Filtration; Humans; Image Enhancement; Kidney; Kidney Diseases; Organometallic Compounds; Prolapse; Pyelonephritis; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid

Separate measurement of renal function is essential in children with urinary tract disease. This can be done satisfactorily by means of kidney scintigraphy with technetium 99m-labelled dimercaptosuccinic acid. A retrospective study of the records of 415 children, which comprised renal function tests, radiology and scintigraphy, confirmed the value of the radioisotope technique. Graphs of height, kidney uptake and kidney uptake density in relation to age were established, showing highly significant correlations with renal function tests and intravenous urography results, but many dissociations were encountered. Separate renal function evaluation by radioisotope scintigraphy seems to be more reliable than evaluation extrapolated from measurement of the cortical areas at intravenous urography. In vesico-ureteral reflux scintigraphy makes it possible to detect reflux nephropathy at an earlier stage than with other methods.

Topics: Age Factors; Child; Child, Preschool; Humans; Infant; Kidney; Kidney Diseases; Kidney Function Tests; Radionuclide Imaging; Retrospective Studies; Succimer; Sulfhydryl Compounds; Technetium; Urography; Vesico-Ureteral Reflux

Phosphorus-31 magnetic resonance (MR) spectroscopy was used to study the effects of partial and complete ureteral obstruction on the porcine kidney; results were compared with renal tubular function as determined with technetium-99m dimercaptosuccinic acid (DMSA) scintigraphy. Twenty-seven pigs were used: nine as sham-operated controls, six with partial ureteral obstruction, and 12 with complete ureteral obstruction. P-31 MR spectra and Tc-DMSA scintiscans were obtained weekly over 3 weeks. Partial obstruction caused no significant change in P-31 MR spectra, whereas Tc-DMSA scintiscans showed a 74% decrease in tubular function by the end of 3 weeks. Complete obstruction caused a 43% reduction in the mean adenosine triphosphate (ATP) to inorganic phosphate (Pi) ratio, which paralleled the 96% decrease in Tc-DMSA uptake over 3 weeks. The difference in ATP/Pi ratios between control and completely obstructed kidneys was significant (P less than .01) at 2 and 3 weeks after ligation. These results indicate that radionuclide Tc-99m DMSA uptake is very sensitive to the pathophysiologic changes in renal tubular function, while the organ average cellular bioenergetic state (ATP/Pi) is not as strongly affected.

Topics: Adenosine Triphosphate; Animals; Kidney; Kidney Diseases; Kidney Tubules; Magnetic Resonance Spectroscopy; Organometallic Compounds; Phosphates; Radionuclide Imaging; Succimer; Swine; Swine, Miniature; Technetium Tc 99m Dimercaptosuccinic Acid; Ureteral Obstruction

The efficacy of different radiodiagnostic agents for demonstrating the decline in renal function from cyclosporine (CyA) nephrotoxicity was assessed in rats receiving a standard dose of the drug for 2 wk, compared with control rats. The agents included [99mTc]DTPA, [131I]hippuran, [111In]lysozyme, [99mTc]glucoheptonate (GHA), [99mTc]dimercaptosuccinate (DMS) and [111In]aminated dextran (amdex). A small dose of [99mTc]- or [111In]DTPA was administered simultaneously to normalize the results for variations in drug response from one animal to another. There were statistically significant differences in the detectability of the renal functional impairment by plasma clearance, early and 2-hr renal uptake among the different agents. However, none was clearly superior to DTPA. This conclusion is consistent with previous studies which showed a parallel decline in glomerular filtration rate (GFR) and effective renal plasma flow in acute CyA toxicity probably due primarily to vasoconstriction.

Topics: Animals; Cyclosporins; Indium Radioisotopes; Iodine Radioisotopes; Iodohippuric Acid; Kidney; Kidney Diseases; Male; Organometallic Compounds; Organotechnetium Compounds; Pentetic Acid; Radionuclide Imaging; Rats; Rats, Inbred Strains; Succimer; Sugar Acids; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pentetate; Tissue Distribution

The scintigraphic evaluation of a rare case of parenchymal malakoplakia in a transplanted kidney is presented. Uptake of Tc-99m DMSA in the involved area was reduced and the Ga-67 uptake was increased.

Topics: Gallium Radioisotopes; Humans; Kidney Diseases; Kidney Transplantation; Malacoplakia; Male; Middle Aged; Organometallic Compounds; Radionuclide Imaging; Succimer; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid

In order to test in a prospective study the suggestion that there should be a shift from the intravenous urogram to DMSA scintigraphy for the diagnosis of suspected renal masses, both investigations were performed in 63 patients with painless haematuria. While the sensitivity of both investigations was similar in renal lesions, specificity was slightly less for scintigraphy. These findings, together with the intrinsic limitations of the DMSA scintigram in detecting lesions elsewhere in the urinary tract, lead us to conclude that the intravenous urogram should remain the initial investigation for painless haematuria unless there are specific contraindications.

Topics: Hematuria; Humans; Kidney; Kidney Diseases; Prospective Studies; Radiography; Radionuclide Imaging; Sensitivity and Specificity; Succimer

The findings on 99mTc dimercaptosuccinic acid (DMSA) scans were examined in 54 patients aged 3 to 33 years in whom renal scarring had been diagnosed radiologically in childhood after urinary tract infection. There was no recent history of infection. Vesicoureteric reflux had been present in 48 patients and had stopped in 23 at the time of the DMSA scan. In six of the 72 radiologically scarred kidneys, the DMSA scan appeared normal but scarring would have been overlooked in only two of the 54 patients. DMSA scan changes are non-specific and underestimated individual scars in 21 kidneys. The intravenous urogram and the DMSA scan showed good correlation but should be regarded as complementary investigations in these patients, giving morphological and functional information, respectively. On DMSA scans the timing of any preceding urinary tract infection must be considered in order to differentiate diffuse potentially reversible defects in isotope uptake after urinary tract infection from those due to permanent renal scarring.

Topics: Adolescent; Adult; Age Factors; Child; Child, Preschool; Cicatrix; Female; Humans; Kidney; Kidney Diseases; Male; Organometallic Compounds; Radiography; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid

A total of 115 children under 5 years who presented with a first symptomatic urinary tract infection and who had a 99mTc dimercaptosuccinic acid (DMSA) scan were studied to assess its value and compare the findings with those of other imaging techniques. Renal cortical defects were detected in 65 kidneys by DMSA scan, intravenous urogram, and ultrasound scan combined; 62 (95%) being seen on DMSA scan. The finding of reflux on micturating cystourethrography showed a highly significant correlation with renal defects seen on DMSA scanning, a less close but still significant correlation with abnormalities on intravenous urography, but none with ultrasound scan findings. The sensitivity of the DMSA scan in screening for all grades of reflux is estimated as 0.66, which is higher than that previously reported for the intravenous urogram or ultrasound scan. DMSA scans were less likely to miss grade 3 reflux than the other two methods. DMSA scans are more useful than other upper renal tract imaging techniques in detecting renal defects. Consideration should be given to their use as a first investigation in place of routine intravenous urograms. Ultrasound scans alone will overlook potentially serious urinary tract abnormalities.

Topics: Child, Preschool; Cicatrix; Female; Humans; Infant; Infant, Newborn; Kidney; Kidney Diseases; Male; Organometallic Compounds; Radiography; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Ultrasonography; Urinary Tract Infections; Vesico-Ureteral Reflux

A case of false positive I-131 MIBG imaging for detection of pheochromocytoma is presented. There was an area of increased tracer uptake in the left renal region that showed steadily reducing activity over a period of three days. This raised the suspicion of a dilated renal pelvis, which was later confirmed by Tc-99m DTPA imaging. It is advisable in cases of ambiguous I-131 MIBG imaging to use Tc-99m DTPA rather than Tc-99m DMSA for localizing the kidneys and renal pelvis.

Topics: 3-Iodobenzylguanidine; Adult; Diagnosis, Differential; False Positive Reactions; Humans; Iodine Radioisotopes; Iodobenzenes; Kidney Diseases; Kidney Pelvis; Male; Organometallic Compounds; Pentetic Acid; Pheochromocytoma; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pentetate

Topics: Child; Humans; Kidney; Kidney Diseases; Organometallic Compounds; Radionuclide Imaging; Reference Values; Succimer; Sulfhydryl Compounds; Technetium Tc 99m Dimercaptosuccinic Acid

In this investigation differential kidney function studies were carried out for eight patients with obstructive uropathy and seven patients who did not suffer from obstruction. The aim of this investigation was to determine whether possible retention of 99Tcm-DMSA in the dilated system would lead to overestimation of the functional mass of an obstructed kidney. The clinical examination took place 4 and 24 h after i.v. injection of the 99Tcm-DMSA. From our results we conclude that this is not a major problem. It appeared that the 4 h values are as reliable as the 24 h values in the clinical situation.

Topics: Humans; Kidney Diseases; Organometallic Compounds; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid

Relative and absolute 99Tcm-DMSA uptake measurements were carried out on 25 adult patients among whom there were 23 normal and 25 malfunctioning kidneys. Data were collected at 3 and 6 h post intravenous tracer injection. Four methods of calculating absolute uptake were investigated and evaluated. These were based on: (1) posterior view and measured kidney depth; (2) posterior view and Raynauld's depth; (3) geometric mean assuming kidney thickness is small enough not to introduce self attenuation of counts in the kidney itself; (4) geometric mean taking kidney thickness into account. Whilst (1) and (2) were found to overestimate and underestimate renal uptake by up to 5 and 14%, respectively, (3) and (4) were found to be more accurate and comparable. The measurement of relative DMSA uptake (right to left) showed no change between the 1 and 6 h measurements for both obstructed and non-obstructed kidneys. Based on the results from method 4, the absolute renal DMSA uptake had a mean value of 25.4%, S.D. 8.9% and 30.0%, S.D. 9.2% at 3 and 6 h, respectively, for normal/non obstructed kidneys. For obstructed kidneys (responding to frusemide), the mean uptake was 23.0%, S.D. 7.2 and 25.6%, S.D. 6.7% at 3 and 6 h, respectively. For obstructed kidneys not responding to frusemide, the mean uptake was 16.8%, S.D. 3.9 and 20.6%, S.D. 4.8% at 3 and 6 h, respectively. No correlation was found between absolute DMSA uptake and degree of renal obstruction.

Topics: Adult; Humans; Kidney; Kidney Diseases; Mathematics; Methods; Organometallic Compounds; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid

Topics: Adolescent; Adult; Aged; Aging; Child; Child, Preschool; Creatinine; Female; Humans; Infant; Kidney; Kidney Diseases; Kidney Function Tests; Male; Middle Aged; Organometallic Compounds; Scintillation Counting; Succimer; Sulfhydryl Compounds; Technetium Tc 99m Dimercaptosuccinic Acid; Ureteral Diseases

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

Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Kidney; Kidney Diseases; Kidney Function Tests; Male; Middle Aged; Organometallic Compounds; Succimer; Sulfhydryl Compounds; Technetium Tc 99m Dimercaptosuccinic Acid; Tomography, Emission-Computed

The 99mtechnetium dimercapto-succinic acid scan provides an image of functional renal parenchyma. This static scan has specific indications and cannot be used simply in place of a 99mtechnetium diethylenetriaminepentaacetic acid scan. The major clinical indications for this investigation are the detection and/or evaluation of a renal scar, the small or absent kidney, an occult duplex system, certain renal masses, systemic hypertension or suspected vasculitis. The physiology of the 99mtechnetium dimercapto-succinic acid scan is reviewed briefly.

Topics: Child; Humans; Hypertension, Renal; Kidney; Kidney Diseases; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid

Topics: Child; Humans; Kidney Diseases; Organometallic Compounds; Organotechnetium Compounds; Radionuclide Imaging; Succimer; Sugar Acids; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid

Topics: Child; Child, Preschool; Female; Humans; Infant; Iodohippuric Acid; Kidney Diseases; Male; Organometallic Compounds; Radioisotope Renography; Succimer; Sulfhydryl Compounds; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections

Topics: Glomerular Filtration Rate; Humans; Kidney; Kidney Diseases; Kidney Tubules, Proximal; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid

An abnormal filtration fraction or a significant divergence between a kidney's ability to extract Tc-99m dimercaptosuccinic acid (DMSA) and other function parameters, such as the glomerular filtration rate (GFR) or the effective renal plasma flow (ERPF), could lead to different estimates of relative or absolute renal function, depending on the radiopharmaceutical administered. To evaluate this possible divergence, we measured the relative GFR (I-125 iothalamate), ERPF (I-131 hippurate), and Tc-99m DMSA accumulation in adult male Sprague-Dawley rats with unilateral ureteral obstruction or unilateral ischemia at various times after renal injury. The relative ERPF of the obstructed kidney was significantly greater than the relative GFR at all time periods studied; significant but less dramatic differences were noted comparing DMSA with GFR in obstruction and DMSA and ERPF with GFR in ischemia. In evaluating renal disease, it is important to consider the functional parameter reflected by the administered radiopharmaceutical as well as the underlying disease state.

Topics: Animals; Glomerular Filtration Rate; Hippurates; Iodine Radioisotopes; Iothalamic Acid; Ischemia; Kidney; Kidney Diseases; Male; Radioisotope Renography; Rats; Rats, Inbred Strains; Regional Blood Flow; Succimer; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Ureteral Obstruction

Two hundred-two 99mTc-DMSA renograms for urologic problems were evaluated. Some technical aspects of the examination and the value of the scintigraphic depth estimation are discussed. Pre- and postoperative uptake values in patients with renal surgery and sequential postoperative examinations are considered. The value of DMSA renograms in predicting recovery in obstructive uropathy and in deciding to opt for conservative therapy or nephrectomy is discussed.

Topics: Aged; Child; Follow-Up Studies; Humans; Kidney; Kidney Calculi; Kidney Diseases; Nephrectomy; Postoperative Period; Preoperative Care; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Ureteral Obstruction

The authors report on their experiences in the diagnostics of urological renal diseases gained by 256 kidney scintigraphies of a total of 227 patients. The more important trends of progress made in the recent years in nuclear medicine are outlined. The sensitivity (93%) and specificity (86%) of the examination based on the surgical and histological findings are determined. The technical importance of the study made from several directions using up-to-date radiopharmaca is emphasized in obtaining the results being favourable even in international comparison. The importance of the coordination between the urologists and experts well-versed in nuclear medicine is pointed out in selecting the examination best suited for the purpose (dynamic, static examination). Based on the literature and on their own experiences, the diagnostic results of the examination in detecting and controlling renal diseases are summarized.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Humans; Kidney Diseases; Middle Aged; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid

Combined [99mTc]DMSA kidney scintigraphy and [131I]hippuran renography were performed consecutively in 87 children with recurrent urinary tract infections in a retrospective study. This procedure allows a description of renal cortical morphology, split function determination and run-off evaluation. Signs of cortical scarring were found in 41 of 172 kidneys (24%) and were significantly associated with vesico-ureteral reflux (p less than 0.001) and with delayed urinary run-off (p less than 0.01). Split renal function was significantly reduced in kidneys with unilateral scarring (p less than 0.001). The radio-isotope investigations and intravenous urography were performed within 3 months of each other in 56 patients (110 kidneys). Good agreement between the findings was found except for 13 kidneys, where cortical activity defects were revealed by scintiscan despite normal urography. The extended scintigraphic procedure described is considered useful for urological screening of children with urinary tract infections and may thus replace urography as a first-line investigation. It should be followed by micturition cysto-urethrography when evaluation for vesico-ureteral reflux is indicated.

Topics: Adolescent; Child; Child, Preschool; Female; Hippurates; Humans; Infant; Kidney; Kidney Cortex; Kidney Diseases; Male; Radioisotope Renography; Succimer; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections; Urography

We studied the total and differential renal function by 99mTc-dimercaptosuccinic acid (DMSA) renoscintigraphy and present a formula to estimate the renal depth for the Japanese and the attenuation coefficient which influenced renal uptake. Total renal uptake of 99mTc-DMSA correlated well with creatinine clearance and with the PSP test, and there was a close correlation between its relative uptake and relative function as determined by 99mTc-diethylenetriaminepentaacetic acid (DTPA) renography. Therefore differential renal function test with 99mTc-DMSA renoscintigraphy was found to have clinical utility. We also demonstrated 99mTc-DMSA renoscintigraphy provided useful morphological information.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Evaluation Studies as Topic; Female; Humans; Infant; Kidney Diseases; Male; Middle Aged; Radioisotope Renography; Succimer; Sulfhydryl Compounds; Technetium

A total of 127 patients were examined to determine the efficacy of the use of sonography, angionephroscintigraphy and roentgenocontrast angiography in renal tumors and the importance of these methods in diagnostic studies with suspicion for a renal tumor. All the patients were given ultrasound and radionuclide examination, 86 roentgenocontrast angiography. The study has shown a high sensitivity of all three methods in the diagnosis of sizable renal lesions though each one has a different diagnostic tendency. In vascularized tumors the combined use of sonography and angionephroscintigraphy practically ensures 100% diagnosis in a patient even at the out-patient stage of examination. The main difficulties occur in the differential diagnosis of hypovascular sizable tumors when the comparison of the results of all three methods makes it possible to establish correct diagnosis. The advantage of sonography is the absence of traumatism, that of angiography a possibility to determine the functional activity of both involved and intact kidneys. Roentgenocontrast angiography plays the leading role in defining the involvement of the renal and cava inferior veins by a tumor thrombus.

Topics: Adult; Angiography; Cysts; Diagnosis, Differential; Diagnostic Errors; Female; Humans; Kidney; Kidney Diseases; Kidney Neoplasms; Male; Middle Aged; Radioisotope Renography; Succimer; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Ultrasonography

The clearance of 125I-sodium iothalamate, 131I-sodium hippurate, 99mTc-DMSA, and beta 2-microglobulin were determined in 20 patients with proven or suspected proximal tubular dysfunction and in 18 control patients with various renal diseases. A clear distinction in the relative 99mTc-DMSA clearance was observed between patients with proximal tubulopathy (14%-35%) and control patients (less than 14%). A similar difference between the two groups was found in the relative beta 2-microglobulin clearance. Nine patients with proximal tubulopathy showed an elevated filtration fraction versus only two control patients. The renal handling of 99mTc-DMSA seems to be an indicator of proximal tubular function.

Topics: Adolescent; Adult; Aged; beta 2-Microglobulin; Child; Child, Preschool; Female; Glomerular Filtration Rate; Hippurates; Humans; Infant; Iodine Radioisotopes; Iothalamic Acid; Kidney Diseases; Kidney Tubules, Proximal; Male; Middle Aged; Radionuclide Imaging; Renal Circulation; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid

Topics: Creatinine; Humans; Kidney; Kidney Diseases; Mathematics; Radioisotope Renography; Renal Circulation; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid

Aprotinin (Ap), a low-molecular-weight polypeptide (6500 dalton), is a protease inhibitor which is electively and stably accumulated in the kidney. In 112 adult patients, with either uni- or bilateral renal disease with different degrees of renal impairment (from normal GFR to advanced renal failure), renal scans were performed by means of Ap labelled with 99mTc. Highly satisfactory renal scans were obtained in all patients. In 20 patients with renal failure (serum creatinine 1.8-8.5 mg/dl, mean 4.7) a comparison was made of the renal scans obtained with 99mTc-Ap and with 99mTc-DMSA. 99mTc-Ap was slightly better than 99mTc-DMSA, especially in patients with far advanced renal failure. Some aspects of the pharmacokinetics of 99mTc-Ap were studied in 72 cases. In 22 of these patients plasma clearance of 99mTc-Ap was determined by the single injection method using a two-compartment model. In patients with GFR greater than 90 ml/min plasma clearance of 99mTc-Ap was 67.6 +/- 8.4 SD ml/min. A good correlation was observed between plasma clearance of 99mTc-Ap and GFR (r = 0.74). After IV injection 99mTc-Ap was stably fixed by the kidney. Renal radioactivity remained stable between the second and eighth hour after the injection. Urinary excretion of radioactivity measured in 35 patients in the first and in the second 2-h interval after IV injection of 99mTc-Ap was negligible in all patients (2.7 +/- 1.5 SD percent of the dose in the first 2 h; 2.8 +/- 1.4 SD between the second and fourth hour). 99mTc-Ap is an excellent agent for renal imaging. It also seems promising for renal function studies.

Topics: Adolescent; Adult; Aged; Aprotinin; Humans; Kidney Diseases; Kidney Failure, Chronic; Middle Aged; Nephritis; Organotechnetium Compounds; Pyelonephritis; Radioisotope Renography; Succimer; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid

Topics: Diagnosis, Differential; Humans; Iodohippuric Acid; Kidney; Kidney Diseases; Nephrology; Nuclear Medicine; Organotechnetium Compounds; Pentetic Acid; Radionuclide Imaging; Succimer; Sugar Acids; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pentetate; Urology

The purpose of this prospective study (30 controls and 100 renal patients) is to compare one to each other the values of renal function measured with: 1--the DTPA 99mTc , 2--the DMSA 99mTc , and 3--the creatinine clearance. After the control values being established, correlations are done for the whole group (n = 130) between the creatinine clearance, the DTPA 99mTc clearance and the fixation rate of the DMSA 99mTc . The correlations obtained are:--Clcr Versus Cldtpa = 0,91.--Clcr Versus % Dmsa = 0,90. - Cldtpa Versus % Dmsa = 0,93. and indicate the two isotopic tests performed give similar quantitative results than creatinine clearance. Camera and computer allow to measure the separate renal function one by one, the two isotopic test giving similar values for each kidney. The results of these studies give a good concordance with the observed diseases, except for partial renal artery stenosis. The pyelic retention of DMSA 99mTc product, in condition of ureteral compression, gives a potential overestimation of this test and is a matter to debate. The extreme simplicity and facility of DMSA 99mTc procedures make this investigation accessible to any patient and give excellent morphological and functional tests. DTPA 99mTc clearances--global and separate kidney--give a more sensitive approach than DMSA 99mTc does because vascular captation , elimination rates could be focused. DTPA 99mTc procedure is to be used in patients with transplanted kidney, silent IVP kidney, contrast media contraindication or for exploring glomerular clearance without urine collection.

Topics: Adolescent; Adult; Aged; Child; Creatinine; Humans; Kidney; Kidney Diseases; Kidney Function Tests; Middle Aged; Pentetic Acid; Prospective Studies; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pentetate

Topics: Adolescent; Adult; Child; Female; Glomerular Filtration Rate; Humans; Kidney Diseases; Male; Pentetic Acid; Radiation Dosage; Radionuclide Imaging; Succimer; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pentetate; Ureter; Urinary Catheterization

Algorithms for the estimation of organ volumes have been developed which may provide whole organ volumes and which may or may not, at the operator's choice, take into account any voids which may be contained within the organ. These algorithms have been applied to the estimation of the volume of the kidneys, in normal subjects and in patients with renal disease. The dimensions of the kidneys were similar to those derived from ultrasound study measurements which were performed independently. Kidney volume should prove especially useful in the diagnosis of early graft rejection and in the diagnosis of glomerulonephritis.

Topics: Female; Humans; Kidney; Kidney Diseases; Male; Reference Values; Succimer; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Tomography, Emission-Computed

Using computed tomography, the renal parenchymal volume and tissue-plasma ratio of contrast enhancement, with a bolus injection, were measured, and the latter measurement is believed to indicate regional renal function per unit of parenchymal volume. 67 studies were carried out on 50 patients, 17 of whom were examined pre- and postoperatively. Of these 50 patients, 27 had hydronephrosis, 6 had renovascular disease, 4 had pyelonephritis and the remaining 13 were control patients. The product of tissue-plasma ratio of contrast enhancement and the calculated renal parenchymal volume were found to be in good correlation with the individual renal function measured with 99mTc-dimercaptosuccinic acid and 131I-hippuran. Since this method is reproducible, the kidney being examined may be seen in more detail.

Topics: Creatinine; Hippurates; Humans; Iodine Radioisotopes; Kidney; Kidney Diseases; Kidney Function Tests; Radionuclide Imaging; Renal Circulation; Succimer; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Tomography, X-Ray Computed

In nine patients with different types of proximal tubulopathy and a nearly normal glomerular filtration rate a low uptake of 99mTc-DMSA in kidneys was found. The underlying mechanism seems to be an increased urinary excretion of 99mTc-DMSA. This radiopharmaceutical might be used as a marker of proximal tubular dysfunction.

Topics: Adolescent; Child; Glomerular Filtration Rate; Humans; Infant; Kidney; Kidney Diseases; Kidney Tubules, Proximal; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid

Topics: Chlormerodrin; Citrates; Gluconates; Humans; Kidney Diseases; Mercury Radioisotopes; Organotechnetium Compounds; Radionuclide Imaging; Succimer; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid

Radionuclide renography and renal scanning techniques are ideally suited to the initial and follow-up evaluation of patients with obstructive uropathy. While other modalities are superior in their ability to provide anatomic information, the radionuclide study yields functional information for each kidney without the necessity to resort to invasive studies. In addition, the Nuclear Medicine study is well suited to the evaluation of obstruction where serial studies often are required because of a lower radiation burden compared to urography. This lower radiation dose is especially important in obstruction because of the recurrent nature of several kinds of obstructive uropathy and because of the high incidence in the pediatric age group. The ability to control urine flow rate during the procedure through dehydration or administration of diuretics is an additional benefit. Increasing availability of computerization of nuclear medicine procedures as well as interest in studies employing physiologic intervention (including the diuresis renogram) have assured an important place for radionuclide studies in the evaluation of patients with urinary obstruction.

Topics: Adult; Aged; Female; Furosemide; Humans; Iodine Radioisotopes; Iodohippuric Acid; Kidney Diseases; Male; Pentetic Acid; Pyelonephritis; Radiation Dosage; Radioisotopes; Succimer; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pentetate; Tomography, Emission-Computed; Urinary Calculi; Urinary Tract; Urination Disorders

Topics: Adult; Aged; Female; Humans; Iodine Radioisotopes; Iodohippuric Acid; Kidney Diseases; Male; Middle Aged; Radioisotope Renography; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid

Topics: Child; Child, Preschool; Female; Humans; Infant; Kidney Diseases; Male; Radionuclide Imaging; Succimer; Technetium

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Female; Humans; Iodohippuric Acid; Kidney; Kidney Diseases; Kidney Neoplasms; Male; Middle Aged; Nephrectomy; Radiography; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid

Renal uptake of 99m Tc DMSA was used to evaluate the renal function of 16 healthy subjects (controls) and 115 patients with various urinary tract diseases. Scintigraphic examination was carried out 6 hours after an intravenous injection of the product. In the 16 controls Tc DMSA uptake was 25.7 +/- 2.48% in the right kidney and 24.4 +/- 2.86% in the left kidney. In 36 patients with one single hypertrophied kidney, there was a correlation (r = 0.850) between creatinine clearance and Tc DMSA uptake, which was higher than in normal subjects (39.23 +/- 9.9%). In the group of 68 patients with unilateral (31) or bilateral (37) renal disease, a significant correlation (r = 0,725) was observed between kidney-to-kidney ratios of urea clearance and Tc DMSA uptake, so that renal impairment could be quantified. Quantitative scintigraphy did not appear to be of assistance in the remaining 11 patients with obstructive uropathy, as it overestimated renal function. The results obtained with 99 m Tc DMSA scintigraphy should be helpful in choosing between nephrectomy and conservative surgery and in assessing the degree of compensatory hypertrophy in single kidneys.

Topics: Creatinine; Humans; Kidney; Kidney Diseases; Nephrectomy; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Ureteral Obstruction

Topics: Abscess; Humans; Kidney Diseases; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid

Topics: Adolescent; Adult; Aged; Humans; Iodohippuric Acid; Kidney Diseases; Kidney Function Tests; Kidney Neoplasms; Middle Aged; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid

Topics: Adenocarcinoma; Hemangioma; Humans; Kidney Cortex; Kidney Diseases; Kidney Diseases, Cystic; Kidney Neoplasms; Lipoma; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium

A case report of false-positive renal imaging due to anterior displacement of the upper pole of the left kidney with the patient in the prone position is presented. False imaging can be avoided by imaging the kidneys with the patient in the supine position and with the detector behind the patient.

Topics: False Positive Reactions; Humans; Kidney Diseases; Male; Middle Aged; Posture; Radionuclide Imaging; Succimer; Technetium

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

Topics: Animals; Chelating Agents; Kidney; Kidney Diseases; Liver; Male; Mercury; Penicillamine; Rats; Succimer

In 35 patients, renography with 131I-o-hippurate (OIH) and static renal imaging with 99mTc-dimercaptosuccinic acid (DMSA) were used to measure differential renal function (DRF). The results were compared. Depth correction was applied in both methods. In non-obstructed kidneys (19 patients), both methods revealed nearly identical kidney function (r = 0.98). For completely obstructed kidneys (16 patients), OIH gave a significantly better DRF (14 ml/min) than DMSA. This small difference was of no clinical value. Because DMSA is reported to give unreliable results in unilateral obstructed kidneys, the right ureter was ligated in 8 dogs for 10 days and DRF was measured before and after opening an ureteral fistula. The difference in DRF was about 1% and could be accounted for by the amount of urinary radioactivity collected from the pelvic system after the ligature had been opened. Although DMSA appears to give reliable values in determining DRF, even in obstructed kidneys, OIH is preferred since total clearance values and postrenal urinary dynamics can be determined simultaneously.

Topics: Animals; Dogs; Fistula; Humans; Iodohippuric Acid; Kidney; Kidney Diseases; Metabolic Clearance Rate; Radioisotope Renography; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Ureteral Obstruction

Topics: Adult; Aged; Diagnosis, Differential; Female; Humans; Iodine Radioisotopes; Kidney; Kidney Diseases; Male; Middle Aged; Radionuclide Imaging; Succimer; Technetium

43 patients underwent an extended scintigraphic procedure with 99mTc-dimercaptosuccinylic acid in order to investigate its proper use for diagnosing morphological and functional kidney abnormalities. The group was comprised of patients without renal disease, and patients with diffuse parenchymal disease, obstructive uropathy, renal cysts and renal tumors. The study was followed by 131I-hippurate renography. We propose a simplified routine procedure with scintiphotos taken 10-15 min after injection for topographic information and 120 min after injection for renal morphology. This procedure allows excellent case finding of diffuse parenchymal disease of a special value in cases of radiological non-visualization. The technique is indicated, when iodine contrast media cannot be used for radiological examinations. DMSA studies, however, do not allow safe functional evaluation in all categories of patients. Neither can obstructive nephropathy be diagnosed unless the renal pelvis is dilated. Renal perfusion studies are contaminated by the perfusion of liver and spleen. Nevertheless, a tentative differentiation between cysts and tumours is possible, the former being hypoperfused the latter hyperperfused. When supplemented with gamma camera 131I-hippurate renography, the total scintigraphic procedure will also include split function determination and run-off evaluation.

Topics: Humans; Iodine Radioisotopes; Iodohippuric Acid; Kidney; Kidney Diseases; Kidney Diseases, Cystic; Kidney Neoplasms; Pyelonephritis; Radioisotope Renography; Succimer; Sulfhydryl Compounds; Technetium; Ureteral Obstruction

Topics: Animals; Child; Child, Preschool; Dogs; Humans; Kidney Diseases; Radioisotope Renography; Succimer; Sulfhydryl Compounds; Technetium

The use of 99Tcm-labelled DMSA as a static renal imaging agent has been analyzed semi-quantitatively in 366 patients. Study with this agent proved to be of most value in patients with equivocal space-occupying lesions of the kidney, provided useful information in various destructive diseases of the kidney when used for determining divided renal function but was of little value in chronic renal failure. In 33 patients, the uptake of 99Tcm-DMSA at 3 h as a measure of divided renal function was compared with the uptake of 99Tcm-DTPA from 30 to 150 sec following injection and was found to correlate well. In a series of 7 dogs with induced unilateral renal impairment, divided function determined with 99Tcm-DMSA was found to correlate well with results obtained using 51Cr-EDTA.

Topics: Animals; Dogs; Humans; Kidney; Kidney Diseases; Pentetic Acid; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium

Topics: Adult; Blood Flow Velocity; Humans; Kidney; Kidney Diseases; Male; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium

The basic non-invasive investigation of renal space occupying lesions by excretion pyelography was coupled with ultrasonic scanning. Forty-one patients who have undergone isotopic section scanning as part of their investigative assessment were studied. The conditions investigated included solitary cysts, polycystic kidneys, renal tumours, tumefactive xanthomatous pyelonephritis, renal infarct and non-functioning kidneys. An analysis of the accuracy of isotopic section scanning in these different pathological states was made. Computerised isotopic section renal scanning offers a new non-invasive renal investigative technique.

Topics: Adult; Aged; Computers; Female; Humans; Kidney Diseases; Kidney Diseases, Cystic; Kidney Neoplasms; Male; Middle Aged; Radionuclide Imaging; Succimer; Technetium