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Usefulness of parametric renal clearance images in the assessment of basic risk factors for renalnal clearance images in the assessment of basic risk factors for renal scarring in children with recurrent urinary tract infections
Affiliations- Department of Nuclear Medicine, Medical University of Łódź, Al. Kościuszki 4, 90-419 Łódź, Poland
- Department of Quality Control and Radiological Protection, Medical University, ul. Pomorska 251, 92-213 Łódź, Poland
- Clinic of Pediatric Nephrology, Janusz Korczak Children’s Hospital in Łódź, ul. Piłsudskiego 71, 90-329 Łódź, Poland
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Łódź, ul. Pomorska 251, 92-213 Łódź, Poland
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Abstract
BACKGROUND: Clinically confirmed incidents of acute pyelonephritis (APN) following recurrent infections of urinary tract (UTI) form basic risk factors for renal scarring in children. Vesico-uretheral reflux (VUR) of higher grade is additional risk factor for this scarring. Opinions on diagnostic value of summed sequential images of renal uptake phase (SUM) of dynamic renal scintigraphy in detection of renal scars are diverse. However, several publications point to higher diagnostic efficacy of clearance parametric images (PAR) generated from this study.
The aim of the study. To establish a clinical value of parametric renal clearance images in detection of renal scarring.
MATERIAL AND METHODS: A prospective study was performed in a group of 91 children at the age of 4 to 18 years with recurrent UTI. Clinically documented incidents of APN were noted in 32 children: in 8 cases — one and in the remaining 24 — 2 to 5 (mean 3) incidents. In the remaining 59 patients only infections of the lower part of urinary tract were diagnosed.
Static renal 99mTc-DMSA SPECT study and after 2–4 days dynamic renal studies (99mTc-EC) were performed in every patient not earlier than 6 months after the last documented incident of UTI. PAR images generated from a dynamic study by in-house developed software and SUM images were compared with a gold standard SPECT study.
RESULTS: Percentages of children with detected renal scar(s) with SPECT and PAR methods amounted to 55% and 54%, respectively and were statistically significantly higher (p < 0.0001) than with SUM method — 31%. Scars in children with history of APN detected with SPECT and PAR methods were significantly more frequent than with infections of only lower part of urinary tract (72% vs. 46%; p = 0.017 and 69% vs. 46%; p = 0.036, respectively). A SUM method did not reveal statistically significant differences between frequencies of detection of scars in groups specified above — 38% vs. 27% (p = 0.31). Both SPECT and PAR methods showed also that frequencies of occurrence of renal scars in children with higher grades of VUR were higher than without or with lower grades of VUR: 79% vs. 50% (p = 0.048) and 79% vs. 49% (p = 0.04). A SUM method did not reveal higher frequency of renal scars in children with high VUR grades: 36% vs. 30% (p = 0.44).
CONCLUSION: Results obtained with PAR and SPECT methods were similar. An advantage of PAR over SUM images obtained from a dynamic renal scintigraphy in detection of renal scars in children with UTI was confirmed.
Abstract
BACKGROUND: Clinically confirmed incidents of acute pyelonephritis (APN) following recurrent infections of urinary tract (UTI) form basic risk factors for renal scarring in children. Vesico-uretheral reflux (VUR) of higher grade is additional risk factor for this scarring. Opinions on diagnostic value of summed sequential images of renal uptake phase (SUM) of dynamic renal scintigraphy in detection of renal scars are diverse. However, several publications point to higher diagnostic efficacy of clearance parametric images (PAR) generated from this study.
The aim of the study. To establish a clinical value of parametric renal clearance images in detection of renal scarring.
MATERIAL AND METHODS: A prospective study was performed in a group of 91 children at the age of 4 to 18 years with recurrent UTI. Clinically documented incidents of APN were noted in 32 children: in 8 cases — one and in the remaining 24 — 2 to 5 (mean 3) incidents. In the remaining 59 patients only infections of the lower part of urinary tract were diagnosed.
Static renal 99mTc-DMSA SPECT study and after 2–4 days dynamic renal studies (99mTc-EC) were performed in every patient not earlier than 6 months after the last documented incident of UTI. PAR images generated from a dynamic study by in-house developed software and SUM images were compared with a gold standard SPECT study.
RESULTS: Percentages of children with detected renal scar(s) with SPECT and PAR methods amounted to 55% and 54%, respectively and were statistically significantly higher (p < 0.0001) than with SUM method — 31%. Scars in children with history of APN detected with SPECT and PAR methods were significantly more frequent than with infections of only lower part of urinary tract (72% vs. 46%; p = 0.017 and 69% vs. 46%; p = 0.036, respectively). A SUM method did not reveal statistically significant differences between frequencies of detection of scars in groups specified above — 38% vs. 27% (p = 0.31). Both SPECT and PAR methods showed also that frequencies of occurrence of renal scars in children with higher grades of VUR were higher than without or with lower grades of VUR: 79% vs. 50% (p = 0.048) and 79% vs. 49% (p = 0.04). A SUM method did not reveal higher frequency of renal scars in children with high VUR grades: 36% vs. 30% (p = 0.44).
CONCLUSION: Results obtained with PAR and SPECT methods were similar. An advantage of PAR over SUM images obtained from a dynamic renal scintigraphy in detection of renal scars in children with UTI was confirmed.
Keywords
pyelonephritis, parametric clearance images, renal scarring, urinary tract infections
About this articleTitle
Usefulness of parametric renal clearance images in the assessment of basic risk factors for renalnal clearance images in the assessment of basic risk factors for renal scarring in children with recurrent urinary tract infections
Journal
Issue
Article type
Research paper
Pages
76-80
Published online
2017-05-25
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1313
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1254
DOI
Pubmed
Bibliographic record
Nucl. Med. Rev 2017;20(2):76-80.
Keywords
pyelonephritis
parametric clearance images
renal scarring
urinary tract infections
Authors
Ewa Pietrzak-Stelmasiak
Małgorzata Bieńkiewicz
Wojciech Woźnicki
Krystyna Bubińska
Magdalena Kowalewska-Pietrzak
Anna Płachcińska
Jacek Kuśmierek
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