| 123I-hippuran renal scintigraphy with evaluation of single-kidney clearance for predicting renal scarring after acute urinary tract infection: comparison with (99m)Tc-DMSA scanning. | |
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MedLine Citation:
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PMID: 14602856 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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The value of (123)I-hippuran (OIH) renal sequential scintigraphy (RSS) in predicting the evolution of defects detected by (99m)Tc-dimercaptosuccinic acid (DMSA) scanning during a first episode of acute pyelonephritis (APN) was assessed. METHODS: Fifty-eight children with APN underwent (99m)Tc-DMSA planar scanning and (123)I-OIH RSS during acute infection and at least 5 mo later. Renal lesions found by (99m)Tc-DMSA scanning were classified according to the following (99m)Tc-DMSA grading system: 0 = normal, 1 = 1 lesion, 2 = 2 lesions, and 3 = diffuse damage with renal parenchymal subversion. Renal scarring was diagnosed whenever a renal cortical defect detected at the first (99m)Tc-DMSA examination persisted on the follow-up (99m)Tc-DMSA examination. Single-kidney clearance rate (Cl) was evaluated by a method that was previously validated at our institution and is based on time-activity curves measured on the heart and kidney areas by the region-of-interest technique. RESULTS: (99m)Tc-DMSA scanning showed renal damage in 76 kidneys and had negative findings for the remaining 40 kidneys (2 patients had bilaterally negative findings). (99m)Tc-DMSA scanning determined 40 kidneys to be grade 0, 49 to be grade 1, 21 to be grade 2, and 6 to be grade 3. For (99m)Tc-DMSA grades of 0-3, the corresponding Cl mean values (in mL/min/1.73 m(2) of body surface area [BSA]) were 292 +/- 33, 237 +/- 39, 210 +/- 54, and 140 +/- 53, respectively. The Spearman regression coefficient (R) demonstrated a significant correlation between (99m)Tc-DMSA grade and Cl (R = 0.69, P < 0.0001). Thirty-six of the lesions detected by staging (99m)Tc-DMSA were shown to have recovered on follow-up renal scans, whereas 40 developed scars. A significant difference in Cl was found between the 2 groups (P < 0.0002). The Cl cutoff value was determined by univariate discriminant analysis; a Cl value of 232 mL/min/1.73 m(2) of BSA discriminated best between scarred and nonscarred kidneys, with a specificity, sensitivity, positive predictive value, negative predictive value, and overall accuracy of 95%, 95%, 90%, 97%, and 95%, respectively. CONCLUSION: Cl evaluation, in the course of acute urinary tract infection, is highly valuable in predicting the fibrotic evolution of renal damage detected on acute (99m)Tc-DMSA scanning. Also, our data show close agreement between Cl and the grade determined by staging (99m)Tc-DMSA. |
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Authors:
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Alessio Imperiale; Catia Olianti; Stelvio Sestini; Marco Materassi; Daniela Seracini; Rita Ienuso; Giuseppe La Cava; Seracini Daniela |
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Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: Journal of nuclear medicine : official publication, Society of Nuclear Medicine Volume: 44 ISSN: 0161-5505 ISO Abbreviation: J. Nucl. Med. Publication Date: 2003 Nov |
Date Detail:
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Created Date: 2003-11-06 Completed Date: 2003-12-11 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0217410 Medline TA: J Nucl Med Country: United States |
Other Details:
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Languages: eng Pagination: 1755-60 Citation Subset: IM |
Affiliation:
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Department of Clinical Pathophysiology, University of Florence, Florence, Italy. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Acute Disease Child, Preschool Cicatrix / radionuclide imaging* Female Follow-Up Studies Humans Infant Iodine Radioisotopes / diagnostic use* Iodohippuric Acid / diagnostic use* Kidney / radionuclide imaging* Male Retrospective Studies Technetium Tc 99m Dimercaptosuccinic Acid / diagnostic use* Urinary Tract Infections / radionuclide imaging* |
| Chemical | |
Reg. No./Substance:
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0/Iodine Radioisotopes; 147-58-0/Iodohippuric Acid; 65438-08-6/Technetium Tc 99m Dimercaptosuccinic Acid |
| Comments/Corrections | |
Erratum In:
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J Nucl Med. 2004 Jan;45(1):16 Note: Daniela S [corrected to Seracini D] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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