Childhood Kidney Diseases

Korean Society of Pediatric Nephrology (대한소아신장학회)
권호 표지
DOI QR코드

DOI QR Code

Clinical Significance of Uptake Difference on DMSA Scintigraphy in Pediatric Urinary Tract Infection

  • Kim, Byung Kwan (Department of Pediatrics, Korea University Guro Hospital) ;
  • Choi, Won Jee (Department of Pediatrics, Korea University Guro Hospital) ;
  • Yim, Hyung Eun (Department of Pediatrics, Korea University Ansan Hospital) ;
  • Yoo, Kee Hwan (Department of Pediatrics, Korea University Guro Hospital)
  • Received : 2016.09.12
  • Accepted : 2016.10.19
  • Published : 2016.10.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Disruption of normal renal development can lead to congenital anomalies of the kidney and urinary tract, including renal hypodysplasia. We aimed to clarify whether small kidney size affects clinical manifestations in children with urinary tract infection (UTI). Methods: One hundred fifty-four patients who had their first symptomatic UTI between January 2014 and June 2015 were enrolled in this study. Differences in kidney size were estimated based on percent uptake of $^{99m}Tc-$ dimercaptosuccinic acid (DMSA) in scintigraphy. The patients who showed more than 10% difference in kidney size on DMSA scintigraphy with none or minimal cortical defects were included in group A. (group A, n=17). Laboratory, clinical, and imaging results were compared with those of the other patients (group B, n=137). Results: Group A had a relatively higher incidence of vesicoureteral reflux than group B (44% vs 20%, P<0.05). The levels of plasma neutrophil gelatinase-associated lipocalin (NGAL) and serum C-reactive protein were significantly higher in group A (193 [64-337] vs 91 [59-211] ng/mL and 4.1 [0.5-11.9] vs 2.1 [0.7-5.3] ng/mL, respectively; all P <0.05). Linear regression analysis revealed that plasma NGAL level strongly correlated with the difference in renal uptake in DMSA scintigraphy in group A ($R^2=0.505$). Conclusion: The difference in kidney size could influence the clinical course and severity of pediatric UTI.

Keywords

References

  1. Song R, Yosypiv IV. Genetics of congenital anomalies of the kidney and urinary tract. Pediatric Nephrology 2011;26:353-364. https://doi.org/10.1007/s00467-010-1629-4
  2. Quirino IG, Diniz JSS, Bouzada MCF, Pereira AK, Lopes TJ, Paixao GM, et al. Clinical course of 822 children with prenatally detected nephrouropathies. Clin J Amer Soc Nephrology 2012;7:444-451. https://doi.org/10.2215/CJN.03400411
  3. Andres-Jensen L, Jorgensen FS, Thorup J, Flachs J, Madsen JL, Maroun LL, et al. The outcome of antenatal ultrasound diagnosed anomalies of the kidney and urinary tract in a large Danish birth cohort. Arch Dis Childhood 2015;309784.
  4. Cain JE, Di Giovanni V, Smeeton J, Rosenblum ND. Genetics of renal hypoplasia: insights into the mechanisms controlling nephron endowment. Pediatr Res 2010;68:91-8.
  5. Dinkel E, Ertel M, Dittrich M, Peters H, Berres M, Schulte-Wissermann H (1985) Kidney size in childhood sonographical growth charts for kidney length and volume. Pediatric Radiology 2010;15:38-43.
  6. Han BK, Babcock DS. Sonographic measurements and appearance of normal kidneys in children. Amer J Roentgenology 1985;145:611-6. https://doi.org/10.2214/ajr.145.3.611
  7. Schlesinger A, Hernandez R, Zerin J, Marks T, Kelsch R. Interobserver and intraobserver variations in sonographic renal length measurements in children. Amer J Roentgenology 1991;156:1029-32. https://doi.org/10.2214/ajr.156.5.2017927
  8. Rushton HG. The evaluation of acute pyelonephritis and renal scarring with technetium 99m-dimercaptosuccinic acid renal scintigraphy: evolving concepts and future directions. Pediatric Nephrology 1997;11:108-20. https://doi.org/10.1007/s004670050243
  9. Lavocat MP, Granjon D, Allard D, Gay C, Freycon MT, Dubois F. Imaging of pyelonephritis. Pediatric Radiology 1997;27:159-65. https://doi.org/10.1007/s002470050091
  10. Benador D, Benador N, Slosman DO, Nussle D, Mermillod B, Girardin E. Cortical scintigraphy in the evaluation of renal parenchymal changes in children with pyelonephritis. J Pediatrics 1994;124:17-20. https://doi.org/10.1016/S0022-3476(94)70248-9
  11. Piepsz A, Blaufox M, Gordon I, Granerus G, Majd M, O'reilly P, et al. Consensus on renal cortical scintigraphy in children with urinary tract infection. Seminars in Nuclear Medicine. Elsevier, 1999:160-74.
  12. Piepsz A, Colarinha P, Gordon I, Hahn K, Olivier P, Roca I, et al. Guidelines for 99mTc-DMSA scintigraphy in children. European J Nuclear Med 2001;28:BP37-41.
  13. Piepsz A, Tamminen-Mobius T, Reiners C, Heikkila J, Kivisaari A, Nilsson N, et al. Five-year study of medical or surgical treatment in children with severe vesico-ureteral reflux dimercaptosuccinic acid findings. Euro J Pediatrics 1998;157:753-8. https://doi.org/10.1007/s004310050929
  14. Piepsz A, Hahn K, Roca I, Ciofetta G, Toth G, Gordon I, et al. A radiopharmaceuticals schedule for imaging in paediatrics. Euro J Nuclear Med 1990;17:127-9. https://doi.org/10.1007/BF00811439
  15. Mandell GA, Eggli DF, Gilday DL, Heyman S. Procedure guideline for renal cortical scintigraphy in children. J Nuclear Medicine 1997;38:1644.
  16. Fernbach S, Maizels M, Conway J. Ultrasound grading of hydronephrosis: introduction to the system used by the Society for Fetal Urology. Pediatric Radiology 1993;23:478-80. https://doi.org/10.1007/BF02012459
  17. Hellstrom A, Hanson E, Hansson S, Hjalmas K, Jodal U. Association between urinary symptoms at 7 years old and previous urinary tract infection. Arch Dis Childhood 1991;66:232-4. https://doi.org/10.1136/adc.66.2.232
  18. Marild S, Jodal U. Incidence rate of first-time symptomatic urinary tract infection in children under 6 years of age. Acta Paediatrica 1998;87:549-52. https://doi.org/10.1111/j.1651-2227.1998.tb01502.x
  19. Montini G, Tullus K, Hewitt I. Febrile urinary tract infections in children. New England J Med 2011;365:239-50. https://doi.org/10.1056/NEJMra1007755
  20. Jacobson SH, Eklof O, Lins L-E, Wikstad I, Winberg J. Long-term prognosis of post-infectious renal scarring in relation to radiological findings in childhood a 27-year follow-up. Pediatric Nephrology 1992;6:19-24. https://doi.org/10.1007/BF00856822
  21. Zhang Y, Bailey R. A long term follow up of adults with reflux nephropathy. New Zealand Medical J 1995;108:142-4.
  22. Baumer J, Jones R. Urinary tract infection in children, National Institute for Health and Clinical Excellence. Arch Dis Childhood- Education Practice Ed 2007;92:189-92. https://doi.org/10.1136/adc.2007.130799
  23. Newman TB. The new American Academy of Pediatrics urinary tract infection guideline. Pediatrics 2011;128:572-5. https://doi.org/10.1542/peds.2011-1818
  24. Estorch M, Torres G, Camacho V, Tembl A, Prat L, Mena E, et al. Individual renal function based on 99mTc dimercaptosuccinic acid uptake corrected for renal size. Nuclear Med Comm 2003;25:167-70.
  25. Rossleigh, M. A., Farnsworth, R. H., Leighton, D. M., Yong, J. L. Technetium-99m dimercaptosuccinic acid scintigraphy studies of renal cortical scarring and renal length. J Nuclear Med 1998;39:1280-5.
  26. Yim HE, Yim H, Bae ES, Woo SU, Yoo KH. Predictive value of urinary and serum biomarkers in young children with febrile urinary tract infections. Pediatric Nephrology 2014;29:2181-9. https://doi.org/10.1007/s00467-014-2845-0
  27. Kjeldsen L, Johnsen AH, Sengelov H, Borregaard N. Isolation and primary structure of NGAL, a novel protein associated with human neutrophil gelatinase. J Biol Chem 1993;268:10425-32.
  28. Mori K, Nakao K. Neutrophil gelatinase-associated lipocalin as the real-time indicator of active kidney damage. Kidney International 2007;71:967-70. https://doi.org/10.1038/sj.ki.5002165
  29. Supavekin S, Zhang W, Kucherlapati R, Kaskel FJ, Moore LC, Devarajan P. Differential gene expression following early renal ischemia/reperfusion. Kidney International 2003;63:1714-24. https://doi.org/10.1046/j.1523-1755.2003.00928.x
  30. Bolignano D, Donato V, Coppolino G, Campo S, Buemi A, Lacqu aniti A, et al. Neutrophil gelatinase-associated lipocalin (NGAL) as a marker of kidney damage. Amer J Kidney Dis 2008;52:595-605. https://doi.org/10.1053/j.ajkd.2008.01.020
  31. Seo WH, Nam SW, Lee EH, Je B-K, Yim HE, Choi BM. A rapid plasma neutrophil gelatinase-associated lipocalin assay for diagnosis of acute pyelonephritis in infants with acute febrile urinary tract infections: a preliminary study. European J Pediatrics 2014;173:229232.
  32. Sim JH, Yim HE, Choi BM, Lee JH, Yoo KH. Plasma neutrophil gelatinase-associated lipocalin predicts acute pyelonephritis in children with urinary tract infections. Pediatric Res 2015;78:48-55. https://doi.org/10.1038/pr.2015.59
  33. Lee J, Kwon DG, Park SJ, Pai K-S. Discordant findings on dimercaptosuccinic acid scintigraphy in children with multi-detector row computed tomography-proven acute pyelonephritis. Korean J Pediatrics 2011;54:212-8. https://doi.org/10.3345/kjp.2011.54.5.212
  34. Lee SW, Baek SY, Lee SJ. CT of acute pyelonephritis in children: comparison with Tc-99m DMSA scintigraphy. J Korean Radiological Soc 1998;38:933-9. https://doi.org/10.3348/jkrs.1998.38.5.933
  35. Seveus L, Amin K, Peterson CG, Roomans GM, Venge P. Human neutrophil lipocalin (HNL) is a specific granule constituent of the neutrophil granulocyte. Studies in bronchial and lung parenchymal tissue and peripheral blood cells. Histochemistry Cell Biology 1997;107:423-32. https://doi.org/10.1007/s004180050129
  36. Goetz DH, Holmes MA, Borregaard N, Bluhm ME, Raymond KN, Strong RK. The neutrophil lipocalin NGAL is a bacteriostatic agent that interferes with siderophore-mediated iron acquisition. Molecular Cell 2002;10:1033-43. https://doi.org/10.1016/S1097-2765(02)00708-6

Cited by

  1. Predictors of High-grade Vesicoureteral Reflux in Children with Febrile Urinary Tract Infections vol.21, pp.2, 2017, https://doi.org/10.3339/jkspn.2017.21.2.136