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The cases
Published in Chris Schelvan, Annabel Copeman, Jacky Davis, Annmarie Jeanes, Jane Young, Paediatric Radiology for MRCPCH and FRCR, 2020
Chris Schelvan, Annabel Copeman, Jacky Davis, Annmarie Jeanes, Jane Young
If antenatal hydronephrosis is detected, postnatal investigation is recommended. Investigations include an ultrasound of the renal tract to assess renal size and morphology, and the degree of hydronephrosis. A micturating cystogram is required to exclude reflux (up to 30%), and to exclude posterior urethral valves in boys. A DMSA scan is often performed primarily to assess differential renal function and to exclude scarring. Local practice varies.
Urinary system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
Often functional assessment is required for complete evaluation and radionuclide imaging tests form the basis of this: DMSA scan for renal size, divided renal function and scarring.Radionuclide renogram (MAG3 or DTPA renogram) to determine individual dynamic renal function and to estimate the ability of each renal tract to drain effectively.Indirect micturating cystourethrography (MCUG) to assess VUR in children able to void.Voiding cystourethrography (VCUG) using pulsed fluoroscopy is frequently used to assess the lateralisation and severity of VUR when planning treatment and to exclude posterior urethral valves in boys.
Pediatric urology
Published in Joseph S. Sanfilippo, Eduardo Lara-Torre, Veronica Gomez-Lobo, Sanfilippo's Textbook of Pediatric and Adolescent GynecologySecond Edition, 2019
Laurel Sofer, Emilie K. Johnson
DMSA scan provides differential renal function. In duplicated systems, a DMSA can delineate the relative function of the lower and upper pole moieties. VCUG may be used to evaluate for VUR before and/or after intervention. A MAG-3 scan may provide both functional and drainage information about the kidney in concern for obstruction. Functional estimation on a MAG-3 scan is slightly less accurate. Finally, while often unnecessary for the diagnosis, magnetic resonance urography can provide detailed anatomic images for challenging cases. It may be useful in identifying an occult ectopic ureter in an older child with incontinence.
Image focus: renovascular hypertension
Published in Acta Cardiologica, 2020
Sebastiaan Dhont, Chris de Niel, Carlos van Mieghem
A 56-year-old man was referred because of resistant arterial hypertension. Lab results showed renal impairment after recently adding an angiotensin converting enzyme inhibitor: creatinine 1.83 mg/dL (baseline creatinine 0.93 mg/dL) corresponding to a calculated clearance of 41 ml/min/1.73m2 according to the formula of CKD-EPI. A computer tomographic examination of the abdominal blood vessels showed an osteal occlusion of the right renal artery with a hypotrophic occurrence of the right kidney (Figure 1). Renin level on serum was 24.6 ug/L/h; normal values for patients older than 40 years are 0.6–3.0 ug/L/h. Additionally, a dimercaptosuccinic acid (DMSA) renal scan was performed to measure the kidney function: the right kidney turned out to be non-functional (almost absent captation, Figure 2). Studies with DMSA-scan present high specificity and are useful in patients with high probability for renovascular hypertension. After laparoscopic nephrectomy, the antihypertensive drugs could be systematically phased out. During the operation, the renal artery was dissected and confirmed the presence of severe atherosclerosis. Peri-operative renin levels showed extremely high values at the right renal vein and immeasurably low dosage at left renal vein (Table 1). The arterial stenosis thus causes local renal ischaemia which stimulates renin release and activation of the renin-angiotensin-aldosterone system, which in turn results in secondary hypertension.
Short-term outcomes of pyeloplasty vs. nephrectomy in adult patients with ureteropelvic junction obstruction and differential renal function ≤15%
Published in Scandinavian Journal of Urology, 2021
Pedro F. S. Freitas, João A. B. A. Barbosa, David H. Cho, Ana B. M. Boffa, Hiury S. Andrade, Marco A. Arap, Ricardo J. Duarte, William C. Nahas, Miguel Srougi, Victor Srougi
A follow-up Tc-99m DMSA scan was available for 16 patients after pyeloplasty (Figure 2). The mean baseline and postoperative DRF were 9.5 ± 3.4% and 10 ± 7.5% (p = 0.99), respectively. Two individuals had a substantial increase in DRF (15% to 26% and 15% to 29%), whereas two had a substantial drop in DRF (15% to 6% and 5% to 0). The remaining 12 patients showed stable DRF. The median AP diameter of the renal pelvis decreased from 4.9 cm (IQR: 3.6–6.8) to 1.9 cm (IQR: 1.6–2.8) after pyeloplasty (p = 0.01).
Urinary vanin-1 for predicting acute pyelonephritis in young children with urinary tract infection: a pilot study
Published in Biomarkers, 2021
Grażyna Krzemień, Małgorzata Pańczyk-Tomaszewska, Elżbieta Górska, Agnieszka Szmigielska
There were some limitations of this study. This was a single-centre study with small sample size. We did not have a baseline urinary vanin-1 level in healthy children and urine samples were collected for vanin-1 only before antibiotic treatment. It can be useful to check the level of vanin-1 after 1-3 days of treatment. We used EC scan for diagnosing of renal cortical defect, despite the fact that DMSA scan remains a gold standard. Small cohort of children may have affected the results of statistical analysis.