Acid Scintigraphy Research Articles

Mo1015 - The Diagnostic Yield of Gastric pH-Metry During Ambulatory Gastro-Oesophageal Reflux Monitoring

Introduction Catheter-based ambulatory monitoring to study gastro-oesophageal reflux (GER) is conventionally performed using a single pH sensor to detect intra-oesophageal acid. A less-often used system is a dual pH catheter, allowing simultaneous measurement of oesophageal and gastric pH. In our tertiary referral GI Physiology Unit, we routinely perform pHmetry or impedance-pHmetry using dual-pH sensor probes for concurrent oesophageal and gastric pH monitoring. Aim: To evaluate the additional diagnostic yield associated with using gastric pHmetry analysis during gastro-oesophageal reflux pH monitoring. Method We retrospectively evaluated 2916 dual pH reflux studies done in our unit between 2009 and 2016 (pH-only or combined pH-impedance). In patients having ‘off’ PPI studies we looked for evidence of prolonged gastric pH buffering by meals that provoked further investigation with gastric emptying study, and for evidence of gastric achlorhydria. In patients having ‘on’ PPI studies (for investigation of reflux refractory to PPI therapy) we evaluated whether inadequate gastric acid suppression (defined as gastric pH >4 for>50% of study period1) could be seen on gastric pH monitoring. Results 271 patients (9.4%) had studies performed ‘on’ the patient’s current proton pump inhibitor therapy (PPI) to investigate refractory GORD symptoms. 150/271 patients (55% of ‘on PPI’ studies) were shown to require escalation of treatment, due to inadequacy of gastric acid suppression (defined as gastric pH >4 for>50% of 1) The gastric pH profile further contributed to the diagnostic workup in 135 patients studied ‘off’ acid suppressive therapy (5% of ‘off PPI’ cohort). 111 patients with overlapping symptoms of reflux and dyspepsia had prolonged postprandial elevation of gastric pH period study2, prompting suspicion of gastroparesis. 72/111 underwent formal gastric emptying testing on 13C-octanoic acid breath test or scintigraphy, and 59/72 were confirmed to have delayed gastric emptying. Finally, latent gastric achlorhydria (gastric pH >4 for the entire study period) was discovered in 24 patients, thus explaining PPI failure and obviating the need to continue PPI for presumed acid reflux. Conclusion For small extra cost (£5 per study in the UK) and no additional labour (automated gastric pH analysis), intragastric pH profiling in routine GER monitoring contributes to diagnostic yield and subsequent clinical management in three ways: 1) assessing adequacy of gastric acid suppression ‘on PPI’ in the event of persistent symptoms; 2) suggesting underlying gastroparesis in reflux-dyspepsia overlap syndromes; 3) revealing latent gastric achlorhydria. References . Bonapace ES, et al. Dig Dis Sci. 2000Jan;45(1):34–9. . Ooi & Glasinovic, et al. UEG Journal 2016;4(5S):A157–A720.A497.[P0991] Disclosure of Interest J. Ooi: None Declared, P Woodland Conflict with: Reckitt Benckiser (Hull, UK), E Glasinovic: None Declared, K Nikaki: None Declared, S Sonmez: None Declared, E Yazaki: None Declared, D Sifrim Conflict with: Reckitt Benckiser (Hull, UK); Sandhill Scientific (CO, USA)

HOW USEFUL IS 99MTC-DPD SCINTIGRAPHY IN DIAGNOSIS OF CARDIAC AMYLOIDOSIS IN TRANSTHYRETIN V30M FAMILIAL AMYLOID POLYNEUROPATHY?

Background: Previous studies suggested that 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid (DPD) scintigraphy may be useful for early diagnosis of hereditary transthyretin (TTR) related cardiac amyloidosis. However its diagnostic value in V30M TTR familial amyloid polyneuropathy (FAP) remains

Urinary tract infections in children

Urinary tract infections (UTI) are the most common bacterial infections in children. The symptoms are not very specific and range from abdominal pain, poor feeding to nocturnal urinary incontinence. The technique of collecting urine plays an important role for securing the diagnosis. The best way to obtain urine in non-toilet-trained children is catheterization or suprapubic bladder aspiration. In toilet-trained children midstream urine is an acceptable alternative after cleaning the foreskin or labia. In the case of an infection aprompt empirical antibiotic therapy is necessary to reduce the risk of parenchymal scarring of the kidneys. There are different approaches to diagnose vesicoureteral reflux in different countries. The commonly used standard approach in Germany is voiding cystourethrography. In the case of reflux dimercaptosuccinic acid (DMSA) scintigraphy should beperformed additionally to exclude renal scarring (bottom-up approach).

Elucidation of Renal Scars in Children With Vesicoureteral Reflux Using Contrast-Enhanced Ultrasound: A Pilot Study

IntroductionVesicoureteral reflux is a common disorder in children but can result in kidney scarring following acute pyelonephritis. The gold standard diagnostic to detect renal scars in children is 99mTc-dimercaptosuccinic acid (DMSA) scintigraphy. DMSA has a number of limitations including radiation exposure, need for sedation, and radiotracer supply shortages. Contrast-enhanced ultrasound (CEUS) is a technique whereby biocompatible microspheres of inert gas are administered i.v. that reflect ultrasonography sound waves and do not involve radiation. Because the contrast agent is rapidly cleared, contrast images must be obtained within minutes of administration. CEUS has been used in a variety of organ systems, but its use in pediatric kidney diseases is limited.MethodsIn this study, we performed CEUS in 7 children with documented renal scars by radiographic imaging consistent with reflux nephropathy.ResultsIn all subjects, CEUS detected all previously known radiologic abnormalities as well as detecting new areas of hypoenhancing renal parenchyma. None of the patients experienced any serious adverse events.DiscussionThis study represents the first report of using CEUS to characterize renal scars in children with reflux nephropathy. We conclude that CEUS is a highly sensitive, rapid, and cost-effective diagnostic imaging modality for detecting and monitoring renal scars in children with vesicoureteral reflux.

One mutation, two distinct disease variants: unravelling the impact of transthyretin amyloid fibril composition.

Although hereditary transthyretin (h-ATTR) amyloidosis is a monogenetic disease, a large variation in its phenotype has been observed. The common hypothesis of amyloid fibril formation involves dissociation of the transthyretin (TTR) tetramer into monomers that after misfolding reassemble into amyloid fibrils. This notion is partly challenged by the finding of two distinct types of amyloid fibrils. One of these, type A, consists of C-terminal ATTR fragments and full-length TTR, whereas the other, type B, consists only of full-length TTR. All organs of an individual patient contain ATTR deposits of either type A or type B fibrils, and the composition in each individual remains unchanged over time. The finding of two distinct types of ATTR fibrils suggests that there are at least two different pathways in operation for ATTR fibril formation. For the most common European mutation, TTR Val30Met, ATTR fibril composition is related to the outcome of liver transplantation, which is the first successful treatment for the disease, and the penetrance of the trait. In addition, the presence of C-terminal ATTR fragments has an impact on the affinity for various tracers used for noninvasive imaging of amyloid depositions such as 99 m-technetium-diphosphono-propanodicarboxylic acid scintigraphy and positron emission tomography utilizing Pittsburgh component B, and even for the gold standard diagnostic procedure, tissue biopsy stained by Congo red and examined under polarized light. The importance of amyloid fibril composition needs to be taken into consideration when designing clinical trials of treatment modalities, and also in the evaluation of diagnostic methods such as imaging techniques.

Early detection of rheumatoid arthritis in rats and humans with 99mTc-3PRGD2 scintigraphy: imaging synovial neoangiogenesis.

Objectives: To validate 99mTc-labeled arginylglycylaspartic acid (99mTc-3PRGD2) scintigraphy as a means to image synovial neoangiogenesis in joints afflicted by rheumatoid arthritis and to investigate its potential in the early detection and management of rheumatoid arthritis.Methods: Rheumatoid arthritis and osteoarthritis were generated in Sprague Dawley rats by type II collagen immunization and papain injection, respectively. Rats were imaged with 99mTc-3PRGD2 and 99mTc- methyl diphosphonate (99mTc MDP). X-ray images were also obtained and assessed by a radiologist. Immunohistochemistry of αvβ3 and CD31confirmed the onset of synovial neoangiogenesis. The effect of bevacizumab on rheumatoid arthritis was followed with 99mTc-3PRGD2 scintigraphy. A patient with rheumatoid arthritis and a healthy volunteer were scanned with 99mTc-3PRGD2.Results: Two weeks after immunization, a significant increase in 99mTc-3PRGD2 was observed in the joints of the rheumatoid arthritis model though uptake in osteoarthritis model and untreated controls was low. 99mTc-MDP whole body scans failed to distinguish early rheumatoid arthritis joints from healthy controls. The expression of αvβ3 and CD31was significantly higher in the joints of rheumatoid arthritis rats compared to normal controls. In serial 99mTc-3PRGD2 scintigraphy studies, 99mTc-3PRGD2 uptake increased in parallel with disease progression. Bevacizumab anti-angiogenetic therapy both improved the symptoms of the rheumatoid arthritis rats and significantly decreased 99mTc-3PRGD2 uptake. Significantly higher 99mTc-3PRGD2 accumulation was also observed in rheumatoid arthritis joints in the patient.Conclusions: Our findings indicate that 99mTc-3PRGD2 scintigraphy could detect early rheumatoid arthritis by imaging the associated synovial neoangiogenesis, and may be useful in disease management.

Delayed treatment of the first febrile urinary tract infection in early childhood increased the risk of renal scarring.

This study evaluated the controversial relationship between the duration of fever before treatment initiation (FBT) for a febrile urinary tract infection (UTI), with renal scarring based on dimercaptosuccinic acid scintigraphy (DMSA) findings. The inpatient records of 148 children under two years of age with a first episode of febrile UTI were analysed. Acute and repeat DMSA findings, and clinical and laboratory parameters were evaluated. Acute DMSA showed that 76 of the 148 children with a febrile UTI had renal lesions: 20 were mild, and 56 were moderate or severe. Repeat DMSA showed renal scarring in 34 patients. The only factors associated with the development of renal scars in the repeat DMSA were FBT of more than 72 hours, the presence and severity of vesicoureteral reflux and increased procalcitonin levels and absolute neutrophil counts. Multiple regression analysis showed that an FBT above 72 hours was the only significant factor that predicted renal scars. Delay in treatment initiation of 72 hours or more was a risk factor for permanent renal scars after the first episode of febrile UTI. Other associated factors were increased procalcitonin and absolute neutrophil count on admission and the presence and severity of vesicouretal reflux.

Prognostic Significance of Occult Transthyretin Cardiac Amyloidosis in Patients With Severe Aortic Stenosis Undergoing Surgical Aortic Valve Replacement

Aortic stenosis (AS), a common condition affecting 3% of individuals aged >75 years, leads to heart failure and death unless the valve is replaced.1 Recently, patients with concomitant degenerative AS and transthyretin-related cardiac amyloidosis have been reported.2–4 One prospective study investigated the coexistence of cardiac amyloidosis in elderly patients with AS who were referred for an aortic valve replacement (surgical or transcatheter), by using echocardiography, 99mTc-3, 3-diphosphono-1, 2-propanodicarboxylic acid scintigraphy, and endomyocardial biopsy, but no cardiac magnetic resonance; 5 of the 43 patients were diagnosed with wild-type transthyretin-related amyloidosis (wtATTR). Of the 5 patients with wtATTR, only 1 was female (median age, 84 years; range, 76–90 years), and all had advanced heart failure (New York Heart Association III/IV).2 One retrospective analysis included 171 patients with wtATTR, on the basis of clinical presentation, in addition to endomyocardial biopsy, cardiac magnetic resonance, echocardiography with an apical sparing strain pattern, and 99mTc-pyrophosphate scintigraphy; 27 were determined to have AS (mean age, 79 years; 70% male).3 The 2-year mortality rate was not different between patients with and without AS, suggesting that the mortality in patients with both diseases may be driven by ATTR as opposed to a stenotic aortic valve or its treatment.3 Another retrospective study reported 16 patients (mean age, 79±6 years; 81% were men) with concomitant AS and transthyretin cardiac amyloidosis (wtATTR, n=13; Val122I, n=1; no genetic test, n=3).4 After valve replacement (surgical in 63% and via transcatheter in 13%), mortality was 44% (n = 7) during the median 33-month follow-up period.4 These were small cohort or retrospective studies; …

Long-term functional renal outcomes after retroperitoneoscopic upper pole heminephrectomy for duplex kidney in children: a multicenter cohort study.

Retroperitoneoscopic upper pole heminephrectomy (RUHN) in duplex kidney in children remains a challenging procedure with a need for postoperative functional assessment of the remnant lower pole. We aimed to calculate the incidence of long-term functional renal outcomes in these children and examine the effect of age on those outcomes. A multicenter retrospective cohort study of 9years included all patients undergoing RUHN and evaluated by renal ultrasound (US) and dimercaptosuccinic acid (DMSA) scintigraphy pre and postoperatively. Patients were divided in two age groups of ≤12 and >12months. Standard follow-up assessed pre-, intra- and postoperative outcomes using clinical review, US and DMSA. Standard RUHN in lateral position was performed in 30 patients. Five cases were excluded (2 lacks of postoperative DMSA, 3 conversions). Indications for RUHN were non-functioning upper moieties (n=25) caused by ureterocele (n=11), ectopic distal implantation of the ureter with incontinence (n=6) or evolving severe ureterohydronephrosis (n=8). Mean age at surgery was 30±27months, operation time 116±52min and hospital stay 2.8±1days. Long-term follow-up (mean, 7.2±2.7years) with US and DMSA showed that none of the 25 patients had complete loss of lower pole renal function. Mean lower pole renal function directly related to RUHN was not significantly different after versus before RUHN for the entire cohort (n=24; 39.7±7.90% vs. 41.7±6.74%; p=0350), for the ≤12-month (n=6; 39.3±4.18 vs. 41.3±5.47; p=0.493) and the >12-month groups (n=18; 39.8±8.90 vs. 41.9±7.25; p=0.443). Four patients (17%) had partial loss of function (mean function loss, 9.3±5.85%; median age, 13months). The number and type of complications between the two age groups were not statistically different. Overall, 29% (n=7/24) of the patients presented with medium-term (17%) and long-term (17%) complications directly related to RUHN. RUHN is a demanding yet efficient technique that is safe for the lower pole at any age. Systematic postoperative DMSA is not mandatory as long as US remains normal.

Pilot study for left ventricular imaging phenotype of patients over 65years old with heart failure and preserved ejection fraction: the high prevalence of amyloid cardiomyopathy.

This study sought to phenotype patients over 65years old with heart failure and preserved ejection fraction (HFpEF) using clinical available comprehensive cardiovascular imaging modalities. Forty-nine patients with HFpEF and without coronary artery disease underwent clinical evaluation, electrocardiography, echocardiography, cardiac magnetic resonance (CMR) and 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid scintigraphy (99mTc-DPD). The mean population age was 76 ± 8 years. Most of the patients (53 %) were NYHA class II. Mean NT-Pro-NBNP level was 1961 ± 2372pg/ml. CMR exhibited a hypertrophic cardiomyopathy or infiltrative pattern in 3 (6 %) and 15 (31 %) patients, respectively. In the latter subgroup, 99mTc-DPD was suggestive of transthyretin-related cardiac amyloidosis for nine (18 %) patients, while AL amyloidosis was proven in five patients (10 %) by extracardiac (n = 3, 6 %) or endomyocardial (n = 2, 4 %) biopsies-one patient declined tissue biopsy. Compared to patients with unspecified cardiomyopathy (n = 31), patients with amyloid cardiomyopathy (n = 15 or n = 14/proven) had less hypertension, lower systolic blood pressure and higher NT-pro BNP level. Their electrocardiogram showed lowest QRS voltage and longer QRS duration. Left ventricular (LV) pattern was characterized by a more pronounced LV hypertrophy, a smaller ejection fraction and a decrease of global longitudinal strain associated with an increase of longitudinal strain apical-to-basal ratio. In patients over 65years, HFpEF is a heterogeneous syndrome with at least a 29 % prevalence of amyloid cardiomyopathy. Combined CMR and 99mTc-DPD are helpful imaging tools for accurate phenotyping of patients amenable to histopathological diagnosis or genetic testing, and should be considered for proper management of this population. Further longitudinal investigations are needed to better clarify these preliminary results.

Accuracy of 99mTc (V)-Dimercaptosuccinic Acid Scintigraphy and Fecal Calprotectin Compared with Colonoscopy in Localizing Active Lesions in Inflammatory Bowel Disease.

INTRODUCTION Due to limitation of colonoscopy in assessing the entire bowel and patients’ intolerance in inflammatory bowel disease (IBD), in the current study, we aimed to prospectively compare the accuracy of 99mTc(V)-dimercaptosuccinic acid (DMSA) and fecal calprotectin with ileocolonoscopy as new methods for localizing inflammations. METHODS Current prospective study conducted between 2012 and 2014 on 30 patients with IBD attending Gastroenterology Clinic of Tehran University of Medical Sciences. Fecal calprotectin and disease activity were measured for all participants and all of them underwent 99mTc (V)-DMSA scintigraphy and colonoscopy. The accuracy of 99mTc (V)-DMSA scintigraphy and calprotectin in localizing bowel lesions were calculated. RESULTS A total of 22 patients with ulcerative colitis (UC) and 8 patients with Crohn’s disease (CD) were evaluated in our study. Sensitivity, positive likelihood ratio (PLR), and positive predictive value (PPV) of scintigraphy and calprotectin over colonoscopy in localization of UC lesions were 86.36%, 0.86%, 100.00% and 90.91%, 0.91, and 100.00%, respectively. Meanwhile, it showed 66.67% sensitivity and 81.25% specificity with PLR=3.56, negative likelihood ratio (NLR)=0.41, PPV=84.21%, and negative predictive value (NPV)= 61.90% in localizing lesions in patients with CD. The calprotectin level had sensitivity, PLR, and PPV of 90.00%, 0.90, and 100.00% in detecting active disease over colonoscopy, respectively. CONCLUSION The 99mTc (V)-DMSA scintigraphy would be an accurate method for detecting active inflammation in follow-up of patients with IBD and assessing response to treatment as a non-invasive and complementary method beside colonoscopy for more accurate diagnosis of CD or UC.

Management of a massive choledochal cyst in a 12 year-old girl: Which imaging modalities should be performed preoperatively?

Abstract A previously well 12 year-old girl presented to the emergency department with a three-day history of fatigue, pruritus, and epigastric discomfort. Abdominal ultrasound revealed a cystic mass in the right upper quadrant measuring 17.0 × 13.2 × 11.7 cm. Magnetic resonance imaging (MRI) confirmed the diagnosis of a choledochal cyst and hepatobiliary iminodiacetic acid (HIDA) scintigraphy demonstrated a communication between the cyst and biliary tree. Percutaneous cholangiography was also performed but did not provide additional diagnostic information. The patient was brought to the operating room a few days later for open resection of the choledochal cyst, cholecystectomy, and Roux-en-Y hepaticojejunostomy. Frozen sections were obtained to ensure complete excision of cyst mucosa. The patient continues to do well more than 18 months post-operatively with no signs of recurrent inflammation or malignancy. Multiple imaging modalities may be used preoperatively to assess the anatomy and subtype of choledochal cysts. The role of invasive options, such as percutaneous cholangiography or endoscopic retrograde cholangiopancreatograpy (ERCP), remains limited and unclear. Here, we present a potential imaging algorithm to assist with preoperative workup and avoid invasive diagnostic procedures whenever possible.

Su1252 Utility of Bile Acid Scintigraphy in the Diagnosis of Remnant Gastritis in Patients With Roux-en-Y Gastric Bypass

Su1252 Utility of Bile Acid Scintigraphy in the Diagnosis of Remnant Gastritis in Patients With Roux-en-Y Gastric Bypass

Does Volume Translate in Function in Interstage Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy?: Commentary on "Drop of Total Liver Function in the Interstages of the New Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy Technique: Analysis of the Auxiliary Liver by Hepatobiliary Iminodiacetic Acid Scintigraphy".

Does Volume Translate in Function in Interstage Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy?: Commentary on "Drop of Total Liver Function in the Interstages of the New Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy Technique: Analysis of the Auxiliary Liver by Hepatobiliary Iminodiacetic Acid Scintigraphy".

Vesicoureteral Reflux and Renal Scarring Risk in Children after the First Febrile Urinary Tract Infection

Background/Aims: There are many controversies regarding the best approach for evaluating children after their first febrile urinary tract infection (UTI). The aim of this study was to define the clinical, laboratory, and radiological features of patients with their first febrile UTI and to investigate the factors that might predict the presence of vesicoureteral reflux (VUR) and renal scarring. Methods: The files of patients who were followed due to their first febrile UTI between 2008 and 2013 were retrospectively reviewed (n = 300). Patients were divided into groups based on their age, the resistance state of microorganisms, the presence of VUR, and scarring on Tc99m dimercaptosuccinic acid scintigraphy. The chi-square test and Mann-Whitney U test were used for analysis. Results: The median age at the first febrile UTI was 11 months and girls constituted 77% of the patient population. VUR and renal scarring were detected in 30.9 and 19.4% of the patients, respectively. C-reactive protein levels and the presence of renal scarring were significantly higher in patients with VUR (p < 0.05). Abnormal ultrasonography findings, VUR and recurrent UTIs were significantly higher in patients with renal scars (p < 0.001). In multivariate analysis, we did not detect any factor that might predict the presence of VUR and renal scarring. Conclusion: A majority of children had their first febrile UTI at a young age. Although we could not find any factor that might predict the VUR and scar risk in patients with their first febrile UTI, an abnormal renal scan at 6 months after infection was closely related with the presence of VUR and recurrent UTIs.

Antireflux surgery does not change ongoing renal functional deterioration

Aim Treatment modalities of vesicoureteral reflux (VUR) consist of antimicrobial prophylaxis and antireflux surgery. In this study, we aimed to determine if antireflux surgery changes the course of renal functional deterioration in children with VUR and urinary tract infections (UTI). Methods Medical files of patients with VUR diagnosed during evaluation for UTI were evaluated retrospectively for gender, age, follow-up period, and renal ultrasonography (US) and serial 99mTc-dimercaptosuccinic acid (99mTc-DMSA) scintigraphy findings. Estimated glomerular filtration rate and urinary protein levels were determined at the initial and last visits, and before the operation in children who had antireflux surgery. The patients were divided into two groups as solely medically treated (Group 1) and both medically and surgically treated (Group 2). Group 2 was further divided as those with stable renal function (Group 2a) and with progressive renal injury (Group 2b). Results There were 140 patients (77 female; mean age 51.6 ± 51.9 months). Group 1 and Group 2 included 82 and 58 patients, respectively. In Group 2, the number of patients with the abnormal US, DMSA scintigraphy, and renal function was higher than in Group 1. Recurrent UTI rate was similar, but progressive scarring was more prominent in the antireflux surgery group. In Group 2, 31 patients had a stable renal function (Group 2a) while 27 had progressive deterioration of renal functions (Group 2b). These subgroups were not different with respect to the rate of high-grade VUR, the presence of a renal scar in DMSA, and UTI recurrence. However, the bilateral renal scar was more common in Group 2b. Conclusion Antireflux surgery does not change the course of ongoing renal injury and renal functional deterioration.

Acute renal infarction: a single center experience.

Acute renal infarction is a rare condition whose diagnosis is often delayed. Major risk factors include atrial fibrillation, valvular or ischemic heart disease, renal artery thrombosis/dissection and coagulopathy. We reviewed the medical records of 18 patients admitted to our Nephrology Department between 1999 and 2015 for acute renal infarction diagnosed by computed tomography. Tc-99m dimercaptosuccinic acid (DMSA) scintigraphy was performed in some patients during follow-up to assess parenchymal lesions and estimate differential kidney function. Mean age was 59.8years. Major associated risk factors included hypertension (44%), obesity (33%), atrial fibrillation (28%), peripheral vascular disease (17%), smoking (17%), prior thromboembolic event (11%), diabetes (11%), estroprogestinic therapy (11%). Seventy-two percent of patients presented with flank pain. Mean serum creatinine was 1.2±0.6mg/dl. Acute kidney injury occurred as the initial manifestation in two patients. Patients were managed conservatively, with low molecular weight heparin (83%) or aspirin (11%). At the end of follow-up serum creatinine was 1.1±0.3mg/dl; one patient remained on chronic hemodialysis. 58% of patients who underwent renal scintigraphy after a median of 8months had a reduced contribution of the previously affected kidney to total renal function. Risk factors associated with the development of chronic kidney disease following renal infarction are unknown. In our subjects, renal function remained stable in all but one patient who developed end stage renal disease. Further studies should focus on etiology and evolution of kidney function in patients with acute renal infarction.

Association between Elevated Alanine Aminotransferase and Urosepsis in Children with Acute Pyelonephritis.

PurposeThe aim of this study is to investigate the association between elevated alanine aminotransferase (ALT) and urosepsis in children with acute pyelonephritis (APN).MethodsWe retrospectively identified all children who were managed in our hospital with APN during a decade period. In our study a diagnosis of APN was defined as having a positive urine culture and a positive (99m)Tc-dimercaptosuccinic acid scintigraphy. We compared those with elevated ALT and those with normal ALT according to the following variables: age, gender, duration of fever prior to admission, presence of hypotension, C-reactive protein (CRP), creatinine, presence of anemia, white blood cells count, platelet count, blood culture result, and grades of vesicoureteral reflux. In addition, the correlation between elevated ALT and positive blood culture was analyzed in detail.ResultsA total of 996 children were diagnosed with APN, of which 883 were included in the study. ALT was elevated in 81 children (9.2%). In the analysis of demographic characteristics, the number of children with elevated ALT was higher in children between 0 to 3 months, boys, and in those with positive blood culture (p=0.002, 0.036, and 0.010, respectively). In multivariate analysis of variables associated with positive blood culture, age younger than 3 months, elevated ALT, elevated CRP, and elevated creatinine showed statistical significance (p=0.004, 0.030, 0.043, and 0.044, respectively).ConclusionOur study demonstrates the association between elevated ALT and increased prevalence of urosepsis in addition to elevated CRP, elevated creatinine, and age younger than 3 months in children with APN.

Urine interleukin-6, interleukin-8 and transforming growth factor β1 in infants with urinary tract infection and asymptomatic bacteriuria.

IntroductionUrinary tract infection (UTI) occurs in 1.1% of girls and 1.4% of boys during the first year of life. Asymptomatic bacteriuria (ABU) is usually detected incidentally in 0.9% of girls and 2.5% of boys at this age. The aim of the study was to assess the usefulness of measurement of pro-inflammatory urine interleukin (IL)-6 and IL-8 concentrations and anti-inflammatory transforming growth factor β1 (TGF-β1) level in infants with febrile UTI, non-febrile UTI and ABU.Material and methodsA total of 35 children, mean age 6.14 ±3.47 months, were divided into three groups: group I – febrile UTI (n = 13), group II – non-febrile UTI (n = 13) and group III – ABU (n = 9). At the time of enrollment urine IL-6, IL-8, TGF-β1 and serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and white blood cell count (WBC) were measured. Renal ultrasound was performed in all children, 99mTc-dimercaptosuccinic acid scintigraphy (DMSA) and voiding cystourethrography in children with UTI.ResultsUrine concentrations of IL-6 and IL-8 were significantly higher in febrile UTI compared to those with non-febrile UTI and ABU (p < 0.5, p < 0.01) and positively correlated with CRP, ESR and WBC (p < 0.01). Urine levels of TGF-β1 were significantly higher in children with febrile UTI compared to those with ABU (p < 0.05) and positively correlated with WBC (p < 0.01). Inflammatory changes in the DMSA scan were detected in 66.6% of children with UTI. No significant difference in frequency of an abnormal DMSA scan compared to a normal scan was found in groups with febrile and non-febrile UTI. No relations between urine cytokines, systemic inflammatory markers and changes in DMSA scan were observed. The cutoff value for detection of inflammatory changes in the DMSA scan for IL-8 was 120 pg/mg creatinine (Cr) and 40 pg/mg Cr for TGF-β1. Based on this value, the sensitivity for IL-8 was 58.3%, specificity 100% and for TGF-β1 66.7% and 83.7%, respectively.ConclusionsWe found significant differences in children with febrile UTI and ABU regarding urine IL-6, IL-8 and TGF-β1 levels. Urine cytokines and systemic inflammatory markers do not differentiate between upper and lower UTI in infants.

Renal shear wave velocity and estimated glomerular filtration rate in children with chronic kidney disease.

A shear wave velocity (SWV) value obtained by the acoustic radiation force impulse technique depends on tissue elasticity. We investigated the relationship between SWV values and the estimated glomerular filtration rate (eGFR) in children with chronic kidney disease. A total of 29 patients were enrolled in the study. There were 18 primary and 11 secondary cases of vesicoureteral reflux. eGFR was calculated using Schwartz's formulas (2012). Partial eGFR for each kidney was assessed by multiplying the eGFR by the percentage of renal function measured by means of renal (99m)Tc-dimercaptosuccinic acid scintigraphy. All ultrasound tests were done by a single qualified technician using a convex probe (frequency 4 MHz) on an S-2000 system. The mean SWV values of the two kidneys were significantly and negatively correlated with eGFR calculated with both univariate (cystatin C [Cys C] and multivariate (creatinine, Cys C, and nitrogen) equations. Of all the formulae, the strongest correlation was obtained with eGFR (Cys C). SWV of the renal cortex correlates with the eGFR of patients affected by malformative uropathies. Nevertheless, this technique needs standardization and validation.