technetium-tc-99m-gluceptate and Urinary-Tract-Infections

There is controversy regarding the role of radiological imaging for urinary tract infection (UTI). The "gold standard" has been the intravenous pyelogram (IVP). Yet, the IVP has a very limited value with only about 25% of children with pyelonephritis demonstrating abnormalities. Ultrasound (US) has recently been advocated as a replacement for the poorly sensitive and poorly specific IVP. However, comparative studies between US and IVP indicate only an equivalent sensitivity and specificity. Cortical scintigraphy with Technetium-99m glucoheptonate (99mTc GH) or 99mTc dimercaptosuccinic acid (99mTc DMSA) has also been advocated as a means of differentiating parenchymal (pyelonephritis) from nonparenchymal (lower UTI) involvement in UTI. The clinical presentation may be misleading especially in the infant and child in whom an elevated temperature, flank pain, shaking chills, or an elevated sedimentation rate are often lacking. The clinician attempts to localize the site of infection for it has a direct bearing upon the therapy. A collecting system infection can often be eradicated with a single oral dose of an appropriate antibiotic, whereas renal parenchymal involvement requires IV therapy for an extended interval. Cortical scintigraphy can localize the site of infection with a high degree of accuracy. Recent studies report a sensitivity of 86% and specificity of 81% of pyelonephritis. This is in contrast to the IVP with a sensitivity of only 24% and US with a sensitivity of only 42%. The scintigraphic appearance of parenchymal infection of the kidney is a spectrum of minimal to gross defects reflecting the degree of histologic involvement that spans from a mild infection to frank abscess. Cortical scintigraphy can be used to monitor the evolution of scarring following infection. Cortical scintigraphy with 99mTc DMSA or 99mTc GH is the method of choice for the initial evaluation of UTI. Not only does it have a very high sensitivity and specificity for differentiating parenchymal from collecting system disease, but it also provides an accurate quantitative measurement of function and in combination with radioiodinated orthoiodohippurate renography and Lasix (furosemide; Abbott Laboratories, North Chicago) diuresis will also differentiate significant obstruction from stasis. The use of radionuclide techniques opens new vistas for the investigation of UTI. Cortical scintigraphy should become the gold standard by which other technologies, therapy, and theoretic

Topics: Child; Child, Preschool; Humans; Infant; Kidney Cortex; Organotechnetium Compounds; Pyelonephritis; Radionuclide Imaging; Sugar Acids; Technetium; Urinary Tract Infections

We attempted to differentiate pyelonephritis, defined as upper urinary tract parenchymal infection, from fever due to other sources in patients with spinal cord injury by radioisotope renal scintigraphy.. A total of 13 consecutive spinal cord injury patients 21 to 54 years old (level of injury C4 to cauda equina) was hospitalized with urosepsis. The diagnosis was based on medical history, physical examination and laboratory evaluation, including blood, urine, sputum and wound fluid culture and sensitivity, and a 99mtechnetium glucoheptonate renal scan for pyelonephritis. Renal scan results were compared to 1 or more of several studies performed in each case, including ultrasonography, excretory urography and axial computerized tomography.. Glucoheptonate renal scintigraphy accurately diagnosed pyelonephritis in all 7 patients with a scintigraphic B lesion. In 2 patients with a C lesion on scintigraphy, representing a cortical scar, other sources of sepsis were identified. In the 4 patients with negative renal scans pyrexia was attributed to active decubitus wound infection and osteomyelitis. Positive and negative predictive values of renal scanning were each 100%.. Nuclear medicine renal scanning is a valuable adjunct in the evaluation of sepsis and presumed urosepsis in the spinal cord injury population.

Topics: Adult; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Organotechnetium Compounds; Pyelonephritis; Radioisotope Renography; Spinal Cord Injuries; Sugar Acids; Urinary Tract Infections

To compare the findings of renal ultrasonography (RUS), 99mTc glucoheptonate renal scan (GHS), and voiding cystourethrography (VCUG) in children with urinary tract infection.. Prospective, masked, clinical study.. Single center, multidisciplinary, inpatients.. Consecutive cases (N = 50) of children aged 2 months to 15 years (8 boys, 42 girls) with pyelonephritis in whom uroradiologic investigation was indicated.. All patients underwent GHS, 48 had RUS, and 2 had intravenous pyelography. All but one of the patients had a VCUG. Fifteen children were found to have vesicoureteral reflux (6 unilaterally, 9 bilaterally). Of 96 kidneys evaluated by both GHS and RUS, 53 were abnormal by GHS versus 28 by RUS (p < 0.001). Findings of both GHS and US were normal in 36 kidneys and abnormal in 21 kidneys. In 32 kidneys only GHS showed abnormalities. In 7 kidneys only RUS showed abnormalities; 5 of them had mild to moderate pelvic dilation caused by reflux, which was confirmed in all 5 by VCUG. The VCUG demonstrated reflux in another four units with normal GHS and RUS findings. All combined, GHS and VCUG detected 62 of 64 abnormal renal units (96.9%). In the other two cases, RUS showed only focal hyperechogenicity of questionable importance.. In the event that one elects to use GHS for the uroradiologic evaluation of children with urinary tract infection, it can be supplemented by VCUG alone, and RUS can be saved for special cases.

Topics: Acute Disease; Adolescent; Child; Child, Preschool; Female; Humans; Infant; Kidney; Kidney Cortex; Male; Organotechnetium Compounds; Prospective Studies; Radionuclide Imaging; Sugar Acids; Ultrasonography; Urethra; Urinary Bladder; Urinary Tract Infections; Urography

Topics: Child; Child, Preschool; Diagnostic Imaging; Female; Humans; Infant; Male; Organotechnetium Compounds; Pyelonephritis; Radioisotope Renography; Succimer; Sugar Acids; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections; Vesico-Ureteral Reflux

Renal scintigraphy represents the optimal modality for the detection of renal scars. 99mTechnetium-glucoheptonate is rapidly accumulated by the kidney through glomerular filtration and active transport by renal tubular cells. This permits rapid visualization of the renal parenchyma in the early phase (1 to 3-minute images) and subsequent imaging of the collecting system and ureters. About 10 to 15 per cent of the injected activity remains in the kidney, labeling the cells of the proximal convoluted tubules (late phase or 1 to 2-hour images). The late phase has been used more commonly to assess renal parenchymal damage. Early and late phase glucoheptonate scanning was performed in 42 children as part of the evaluation of recurrent febrile urinary tract infections with or without a history of vesicoureteral reflux. Inter-observer reliability to interpret glucoheptonate scans was good (early, 83 per cent agreement and late, 93 per cent agreement). The ability of glucoheptonate scanning to detect renal scarring in children with febrile urinary tract infections was equivalent with the early or late phase of the study. In 6 patients renal scarring was detected on only the early phase scan and in 7 scarring was detected only in the late phase. Although the detection rates are equivalent the over-all detection of scarring is improved by using both phases. Therefore, the early phase of the glucoheptonate scan may be a valuable adjunct to conventional glucoheptonate scan methodology used for the detection of renal scarring in children with recurrent urinary tract infections.

Topics: Adolescent; Child; Child, Preschool; Cicatrix; Evaluation Studies as Topic; Humans; Infant; Kidney; Organotechnetium Compounds; Prospective Studies; Pyelonephritis; Radionuclide Imaging; Sugar Acids; Technetium; Urinary Tract Infections

Infection is the most common disease of the urinary tract in children, and various imaging techniques have been used to verify its presence and location. On retrospective analysis, 50 consecutive children with documented upper urinary tract infection had abnormal findings on renal cortical scintigraphy with 99mTc-glucoheptonate. The infection involved the renal poles only in 38 and the poles plus other renal cortical areas in eight. Four had abnormalities that spared the poles. Renal sonograms were abnormal in 32 of 50 children. Excretory urograms were abnormal in six of 23 children in whom they were obtained. Vesicoureteral reflux was found in 34 of 40 children in whom voiding cystourethrography was performed. These data show the high sensitivity of renal cortical scintigraphy with 99mTc-glucoheptonate in documenting upper urinary tract infection. The location of the abnormalities detected suggests that renal infections spread via an ascending mode and implies that intrarenal reflux is a major contributing factor.

Topics: Acute Disease; Adolescent; Child; Child, Preschool; Female; Humans; Infant; Kidney Diseases; Male; Organotechnetium Compounds; Radionuclide Imaging; Retrospective Studies; Sugar Acids; Technetium; Tomography, X-Ray Computed; Ultrasonography; Urinary Tract Infections; Urography; Vesico-Ureteral Reflux

A retrospective study was performed of 39 children at the Children's Memorial Hospital, Chicago, Illinois, who underwent technetium-99m glucoheptonate (99mTcGH) scintigraphy for evaluation of possible urinary tract infection. Clinical and laboratory criteria classified the children as having pyelonephritis, cystitis, or no urinary tract infection. Of 28 children classified as having pyelonephritis, 24 (86%) children had abnormalities on 99mTcGH scintigraphy. Only 8 of 19 (42%) renal ultrasound scans and 4 of 17 (24%) intravenous pyelography studies performed in these children demonstrated findings consistent with parenchymal disease. Only 9 of 19 (47%) cystograms demonstrated vesicoureteral reflux. Three children who underwent gallium-67 citrate scintigraphy had localization at the sites of focal defects with 99mTcGH scintigraphy. 99mTcGH scintigraphy is a sensitive and specific indicator of renal parenchymal involvement that helps localize urinary tract infection to the kidney.

Topics: Child; Child, Preschool; Cystitis; Female; Gallium Radioisotopes; Humans; Male; Organotechnetium Compounds; Pyelonephritis; Radionuclide Imaging; Retrospective Studies; Sugar Acids; Technetium; Urinary Tract Infections

Major advances in nuclear medicine instrumentation and radiopharmaceuticals for renal studies have occurred during the last decade. Current nuclear medicine methodology can be applied for accurate evaluation of renal function and for renal imaging in a wide variety of clinical situations. Total renal function can be estimated from the plasma clearance of agents excreted by glomerular filtration or tubular secretion, and individual function can be estimated by imaging combined with renography. A major area of radionuclide application is in the evaluation of obstructive uropathy. The introduction of diuretic renography and the use of computer-generated regions of interest offer the clinician added useful data which may aid in diagnosis and management. Imaging is of proven value also in trauma, renovascular hypertension, and acute and chronic renal failure. Methods for the evaluation of residual urine, vesicoureteral reflux, and testicular torsion have achieved increasing clinical use. These many procedures assure a meaningful and useful role for the application of nuclear medicine in genitourinary imaging.

Topics: Adult; Female; Humans; Infant; Iodohippuric Acid; Kidney Failure, Chronic; Male; Middle Aged; Organotechnetium Compounds; Pentetic Acid; Radioisotope Renography; Spermatic Cord Torsion; Succimer; Sugar Acids; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pentetate; Ureteral Obstruction; Urinary Tract Infections; Urologic Diseases; Vesico-Ureteral Reflux