Renogram Research Articles

Effect of percutaneous nephrolithotomy on differential renal function as measured by mercaptoacetyl triglycine nuclear renography

Objectives. To determine the impact on differential renal function of percutaneous nephrolithotomy for complex renal calculi. Methods. From July 1999 to December 2000, 45 patients underwent percutaneous nephrolithotomy. Of these, 19 agreed to participate in the study. All patients completed a quantitative assessment of differential renal function preoperatively and postoperatively with technetium 99m mercaptoacetyl triglycine nuclear renography and serum creatinine measurements. Results. The mean patient age was 49 years (range 11 to 75) for the 13 female and 6 male patients. The mean stone burden was 1432 mm 2 (range 156 to 5220). The mean surgical time was 2.57 hours (range 1.17 to 5.08). The median hospital stay was 2.0 days (range 1 to 19). Of the 19 patients, 13 (68%) were stone free after one procedure. Four patients underwent ureteroscopy with stone extraction for residual fragments. One patient underwent secondary extracorporeal shock wave lithotripsy. One patient underwent nephrectomy for poor renal function. Renal function, for the entire group, increased from 36.8% preoperatively to 38.5% postoperatively. Renal function was preserved in 16 (84%) of 19 patients, including improvement of function in 7 (37%) of 19 patients. Serum creatinine was unchanged in the two groups. Conclusions. Percutaneous nephrolithotomy does not result in loss of renal function when treating complex renal calculi as measured by nuclear scintigraphy. Operative and hospitalization times were decreased compared with historical open nephrolithotomy and stone clearance was similar.

Effect of percutaneous nephrolithotomy on differential renal function as measured by mercaptoacetyl triglycine nuclear renography: Reply by the authors

Effect of percutaneous nephrolithotomy on differential renal function as measured by mercaptoacetyl triglycine nuclear renography: Reply by the authors

NEPHROTOXICITY DUE TO INTERMEDIATE-DOSE METHOTREXATE WITHOUT RESCUE IN AN OBESE ADOLESCENT WITH ACUTE LYMPHOBLASTIC LEUKEMIA

Toxicity from intermediate-dose methotrexate (MTX)is unusual. A severely obese adolescent with acute lymphoblastic leukemia experienced significant, delayed nephrotoxicity from intermediate-dose MTX. Altered MTX disposition may occur as a consequence of other ingestions or conditions such as obesity. The use of radioisotope renography established the diagnosis and followed the resolution of the patient's MTX-induced nephrotoxicity.

Cystometric evaluation of reconstructed classical bladder exstrophy.

To evaluate the association of urodynamic variables with continence and upper tract status after reconstruction in patients with classical bladder exstrophy. Thirty-one patients with bladder exstrophy were assessed 1 year after a modified bladder neck reconstruction. The evaluation included a detailed history, radioisotope renography, voiding cysto-urethrography, ultrasonography and artificial slow-filling cystometry. Fifteen of the 31 patients were satisfactorily continent; their maximum cystometric capacity was higher than that of the incontinent patients. The compliance, assessed as the maximum bladder capacity at a detrusor pressure of < 20 cmH2O, was significantly higher in the continent patients. There was a 45% incidence of unstable contractions in the 31 patients. Persistent sphincteric activity was detected on electromyography in 10 patients during voiding. Twenty-one patients could initiate a detrusor contraction during voiding. The residual volume was significant in nine of the 21 patients who attempted to void. Patients with a high end-fill pressure (> 40 cmH2O) had a significantly higher incidence of unobstructive hydronephrosis than had patients who had an end-fill pressure of < 40 cmH2O. Bladder abnormalities are common after reconstruction of bladder exstrophy, with poor compliance, small capacity and unstable contractions. These factors hinder any increase in capacity and cause persistent incontinence. Hypocompliance and high end-fill pressure can lead to upper tract damage even in continent patients. Detailed urodynamic evaluation is vital to assess the results and to plan subsequent treatment.

ANGIOTENSIN CONVERTING ENZYME INHIBITION WORSENS THE EXCRETORY PHASE OF DIURETIC RENOGRAPHY FOR OBSTRUCTIVE HYDRONEPHROSIS

A growing body of evidence identifies the renin-angiotensin system as a key factor in the onset and progression of renal damage in chronic partial obstruction, which often represents a complex diagnostic challenge. A prospective study was undertaken to evaluate the role of captopril mercaptoacetyltriglycine-3 (MAG-3) renography as an early diagnostic test of obstruction. We report the results in a subgroup of children who underwent surgical correction for pyeloureteral obstruction. Pyeloplasty was performed in 12 patients, including 10 males, 2 to 72 months old (median age 7) with unilateral hydronephrosis, including normal renal function and blood pressure. Basal and captopril enhanced diuretic renography with 99mtechnetium MAG-3 was performed within 24 hours using the same hydration and diuretic stimulus (0.75 mg./kg. furosemide), and 0.75 mg./kg. captopril was administered orally 60 to 90 minutes before scintigraphy. No adverse effects or modifications of the blood pressure were observed after captopril administration. The diuretic response was deeply worsened by angiotensin converting enzyme inhibition in each hydronephrotic kidney even when the basal study was only slightly abnormal (15-minute washout basal -27 +/- 16%, after captopril -9 +/- 13, p <0.005). After surgical correction the diuretic washout during angiotensin inhibition appeared normal in all patients (15-minute washout -56 +/- 14%). Separate renal function and parenchymal transit of MAG-3 were not modified by angiotensin converting enzyme inhibition, preoperatively or postoperatively. Our data confirm the influence of angiotensin on the kidney excretory system in human hydronephrosis and suggest a role for captopril enhanced diuretic renography in the early diagnosis of pyeloureteral obstruction. Further work is needed to evaluate angiotensin converting enzyme inhibition as a protective agent in obstructive nephropathy.

Angiotensin converting enzyme inhibition worsens the excretory phase of diuretic renography for obstructive hydronephrosis.

A growing body of evidence identifies the renin-angiotensin system as a key factor in the onset and progression of renal damage in chronic partial obstruction, which often represents a complex diagnostic challenge. A prospective study was undertaken to evaluate the role of captopril mercaptoacetyltriglycine-3 (MAG-3) renography as an early diagnostic test of obstruction. We report the results in a subgroup of children who underwent surgical correction for pyeloureteral obstruction. Pyeloplasty was performed in 12 patients, including 10 males, 2 to 72 months old (median age 7) with unilateral hydronephrosis, including normal renal function and blood pressure. Basal and captopril enhanced diuretic renography with 99mtechnetium MAG-3 was performed within 24 hours using the same hydration and diuretic stimulus (0.75 mg./kg. furosemide), and 0.75 mg./kg. captopril was administered orally 60 to 90 minutes before scintigraphy. No adverse effects or modifications of the blood pressure were observed after captopril administration. The diuretic response was deeply worsened by angiotensin converting enzyme inhibition in each hydronephrotic kidney even when the basal study was only slightly abnormal (15-minute washout basal -27 +/- 16%, after captopril -9 +/- 13, p <0.005). After surgical correction the diuretic washout during angiotensin inhibition appeared normal in all patients (15-minute washout -56 +/- 14%). Separate renal function and parenchymal transit of MAG-3 were not modified by angiotensin converting enzyme inhibition, preoperatively or postoperatively. Our data confirm the influence of angiotensin on the kidney excretory system in human hydronephrosis and suggest a role for captopril enhanced diuretic renography in the early diagnosis of pyeloureteral obstruction. Further work is needed to evaluate angiotensin converting enzyme inhibition as a protective agent in obstructive nephropathy.

Short-term Arterial Blood Reperfusion of Normothermic Kidney in Renal Artery and Abdominal Aorta Reconstructive Surgery

to prevent kidney injury in renal artery and juxta-renal aortic surgery. After 30 min of cross-clamping ischaemia, renal arterial inflow is temporary re-established for 3 min. The aim of the study was to retrospectively analyse the results of this original technique. between January 1987 and May 1999, 48 patients underwent kidney short-term arterial blood reperfusion, directly or through the Pruitt-Inahara shunt. The reperfusion was repeated every 30 min of ischaemia, whenever necessary. Fifty control patients underwent <30 min of kidney ischaemia. Patients were assessed by serum creatinine, digital angiography and radioisotope renography using technecium(99). in the study group one patient developed an acute renal failure and died (2% (-95% CI: 0-11%)). In both study and control groups patients showed a similar and moderate but temporary decline in renal function, which returned to preoperative levels after 1 week. the results of this study indicate that kidney short-term reperfusion may protect renal tissue from prolonged cross-clamping ischaemia (up to 100 min), also in patients considered at high risk for acute renal failure.

Quantitative analysis of infantile ureteropelvic junction obstruction by diuretic renography.

Infantile hydronephrosis detected by ultrasonography poses a clinical dilemma on how to treat the condition. This article reports a retrospective study to evaluate infantile hydronephrosis due to suspected ureteropelvic junction (UPJ) obstruction by means of standardized diuretic renography and to speculate its usefulness for quantitative assessment and management of this condition. Between November 1992 and July 1999, 43 patients who had the disease detected in their fetal or infantile period were submitted to this study. Standardized diuretic renograms were obtained with 99mTc-labeled diethylene-triaminepenta-acetate (Tc-99m-DTPA) or 99mTc-labeled mercaptoacetyl triglycine (Tc-99m-MAG3) as radiopharmaceuticals. Drainage half-time clearance (T 1/2) of the activity at each region of interest set to encompass the entire kidney and the dilated pelvis was used as an index of quantitative analysis of UPJ obstruction. Initial T 1/2s of 32 kidneys with suspected UPJ obstruction were significantly longer than those of 37 without obstruction. T 1/2s of kidneys which had undergone pyeloplasty decreased promptly after surgery whereas those of units followed up without surgery decreased more sluggishly. These findings demonstrate that a standardized diuretic renographic analysis with T 1/2 can reliably assess infantile hydronephrosis with UPJ obstruction and be helpful in making a decision on surgical intervention.

DETERMINATION OF GLOMERULAR FILTRATION RATE PER UNIT RENAL VOLUME USING COMPUTERIZED TOMOGRAPHY:: CORRELATION WITH CONVENTIONAL MEASURES OF TOTAL AND DIVIDED RENAL FUNCTION

Previous studies suggest that functional computerized tomography (CT) can measure glomerular filtration rate (GFR) per unit renal volume. We compared this index with conventionally determined GFR measurements. A total of 16 men and 8 women 63.3 +/- 14.9 years old (range 31 to 88) were studied using with contrast enhanced CT. A single slice of kidney was scanned sequentially after bolus injection (0.5 to 1.0 ml. per second(-1)) of 20 ml. iopamidol (300 mg. iodine per ml.(-1)). GFR per volume of kidney was calculated using a Patlak graphical analysis, and this index was multiplied by renal volume on CT to yield global GFR (ml. per minute(-1)). Divided function was also calculated. GFR and divided renal function were calculated in all cases from radioisotope renography with 99m diethylenetetraminepentaacetic acid. In 12 subjects in whom 24-hour urine collection was possible GFR was also calculated from creatinine clearance. A strong correlation was observed between divided renal function, expressed with respect to the right kidney calculated from CT (52.7 +/- 14.8%, range 19.9% to 97.4%) and by radioisotope renography (51.7 +/- 14.6%, range 18.9% to 92.6%, r = 0.97, p <0.0001). A strong correlation (r = 0.92, p <0.0001) was also seen between global GFR determined by CT (80.1 +/- 43.9 ml. per minute(-1), range 38.2 to 197.9) and creatinine clearance (72.4 +/- 47.5, range 14.6 to 168.5), and was stronger than the correlation between the radioisotope and creatinine clearance method (r = 0.67, p = 0.02) in the same patients. Functional CT using nonionic contrast material can measure GFR normalized to renal volume and is an accurate alternative to conventional methods of renal function evaluation.

Diagnosis of kidney transplant obstruction using Mag3 diuretic renography.

Kidney transplant obstruction (KTO) following renal transplantation remains an important reversible cause of allograft dysfunction, requiring prompt diagnosis to prevent long-term graft damage. Although ultrasound can accurately diagnose renal transplant hydronephrosis, it cannot be used to assess its functional significance. We prospectively assessed the utility of technetium-99m mercaptoacetyltriglycine (Tc99m MAG3) diuretic renography for the diagnosis of allograft KTO, using standard visual and quantitative parameters, as well as calculated renal output efficiency (OE), which has been postulated to improve diagnostic yield. From a cohort of 45 renal transplant patients, two subgroups were formed. The first group of transplant recipients (n = 21) with stable function and no obstruction was used to derive normal values for Tc99m MAG3 scans. A second group of transplant recipients with acute renal dysfunction in whom KTO was clinically suspected was used to test the diagnostic utility of these derived values (n = 43 scans). KTO was diagnosed independently of the MAG3 scans by a fall in the serum creatinine in response to renal pelvis urinary drainage. OE in 12 renal allografts with KTO was significantly reduced compared with 31 Tc99m MAG3 scans without KTO (59.6 +/- 18.9 vs. 81.6 +/- 5.4%, p < 0.001). In KTO, the mean time of isotope appearance in the bladder (time to bladder [TTB]) was extended compared with unobstructed allografts (7.9 +/- 4.1 vs. 3.6 +/- 1.5 min, p < 0.001). Measurement of OE significantly improved the accuracy of diuretic MAG3 renography in the diagnosis of renal allograft KTO, especially when supplemented by the TTB, parenchymal transit time and shape of the renogram curve. Ureteric obstruction of the kidney transplant can be diagnosed with an OE reduced to < 75% (sensitivity 92%, specificity 87%) and confirmed by isotope hold-up in the pelvicalyceal system. A normal or slowly declining renogram curve effectively excluded KTO (sensitivity of 96%, negative predictive value of 84%). A parenchymal transit time of > 5 min and a TTB of > 7 min both yielded a sensitvity of 92% and a specificity of 81%. In conclusion, MAG3 renography is a clinically useful investigation for the diagnosis of KTO.

Use of sonography and radioisotope renography to diagnose hydronephrosis in patients with spinal cord injury

Tsai S-J, Ting H, Ho C-C, Bih L-I. Use of sonography and radioisotope renography to diagnosis of hydronephrosis in patients with spinal cord injury. Arch Phys Med Rehabil 2001;82:103-6. Objective: To study the accuracy of sonography and radioisotope renography in detecting hydronephrosis in patients with spinal cord injury (SCI). Design: Prospective, blinded comparison study. Setting: Rehabilitation hospital affiliated with a medical college. Participants: One hundred and nine patients with SCI (21 women, 88 men) participated. Interventions: Comprehensive urologic examinations including clinical evaluation, laboratory tests, intravenous urography (IVU), sonography, radioisotope renography (renal scan), voiding cystourethrography, and cystometry. The findings at sonography and renal scan were separately compared with the final diagnosis interpreted by IVU and clinical findings. Main Outcome Measures: Effective renal plasma flow, pyelocaliectasis, and positive and negative predictive value. Results: A total of 235 kidneys were analyzed. Sonography correctly excluded the presence of hydronephrosis in 173 of 192 nonobstructed kidneys. Sonograms were interpreted as positive in 41 of 43 kidneys with documented hydronephrosis. Renal scan correctly excluded 161 nonobstructed kidneys. The renal scan detected 39 of 43 kidneys with hydronephrosis. The sensitivity of sonography was.96 with a specificity of.90. Renal scan reached a sensitivity of.91 with a specificity of.84. Conclusion: Sonography and renal scan are safe, sensitive, and specific for detecting hydronephrosis. Combined use of both methods appears to be a reliable alternative to IVU in the long-term follow-up for patients with SCI with neurogenic bladder dysfunction. © 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Geochemistry and isotopic evolution of the Mesoproterozoic Cape Meredith Complex, West Falkland

Whole-rock major and trace element geochemical and Rb–Sr/Sm–Nd isotopic data are presented for the Mesoproterozoic (∼1.0 Ga) metamorphic and igneous rocks of the Cape Meredith Complex, West Falkland. The data indicate that the oldest rocks, the ∼1.1 Ga supracrustal gneisses of the Big Cape Formation, which form three petrographic and geochemical groups (mafic amphibolite, quartz–plagioclase–biotite–hornblende intermediate gneiss and acid gneiss), probably represent a juvenile calc-alkaline, basalt–andesite–rhyolite volcanic sequence, with epsilon (εNdT) values and NdTDM ages of ∼+3 to +6 and ∼1100 to 1400 Ma respectively. It is argued on geochemical grounds that these metavolcanics were extruded in an island-arc at around 1120 Ma. The Big Cape Formation was intruded by granitoids during and after a collisional orogenic event at around 1090 Ma. The oldest, foliated, (G1) granodiorite was emplaced as thin sheets at approximately 1090 to 1070 Ma and is characterized by εNd values of ∼+1.5 to 4 (TDM = ∼1200 to 1400 Ma), showing its juvenile nature. The ∼1070 Ma (G2) syntectonic granitoid gneisses and ∼1000 Ma G3 post-tectonic granites also exhibit juvenile characteristics (εNd = ∼0 to +5 and TDM = 2200 to 1200 Ma, respectively). The granitoids show a time-composition evolution from Na-rich (G1) granodiorite to potassic, high-High Field Strength Element granites (G3). The geochemical and isotopic characteristics and geological evolution of the Cape Meredith Complex is comparable with that of the adjacent Gondwana crustal blocks in Natal (SE Africa) and Dronning Maud Land (East Antarctica), supporting models that demonstrate these areas evolved in a contiguous, juvenile arc environment prior to, and during, a major orogenic event at ∼1.1 Ga. These events were associated with the birth of the Rodinian supercontinent. The three areas remained juxtaposed during Rodinia break-up and were subsequently incorporated into Gondwana in the same relative positions.

VARIABILITY OF DIURESIS RENOGRAPHY INTERPRETATION DUE TO METHOD OF POST-DIURETIC RENAL PELVIC CLEARANCE HALF-TIME DETERMINATION

We assessed variability in the interpretation of diuresis renography that may result from using different methods of clearance half-time determination. We reviewed 152 diuresis renography studies performed at diagnosis or during followup of 53 children enrolled in a prospective study assessing the natural history of unilateral neonatal hydronephrosis. Studies were classified as nonobstructive, indeterminate or obstructive using 4 methods of half-time determination. Intermethod correlation and agreement were evaluated. We compared the proportion of nonobstructive, indeterminate and obstructive classifications by each method, and the interpretation of individual studies based on each method. Among methods we noted a high degree of correlation and fair to excellent agreement (Spearman rho = 0.86 to 0.92 and kappa = 0.57 to 0.86, respectively). However, in 27.8% of intermethod comparisons the proportion of studies classified as nonobstructive, indeterminate and obstructive differed significantly (p <0.05). The classification of pelvicaliceal drainage varied by method for all but the most severely dilated systems. In individual studies classification by 1 method was discordant with classification by another in 19% of comparisons. Of the discordant interpretations 97.7% involved nonobstructive versus indeterminate or indeterminate versus obstructive classifications. Variability in classifying drainage patterns based on half-time requires that practitioners be circumspect when applying this parameter for managing asymptomatic hydronephrosis. It also necessitates the description of quantitative methodology in published series of this important clinical problem.

MCP-1 and EGF renal expression and urine excretion in human congenital obstructive nephropathy

Obstructive nephropathy is characterized at the histologic level by tubular atrophy and interstitial monocyte infiltration. The molecular mechanisms underlying these histologic changes are still poorly defined. Epidermal growth factor (EGF) produced by tubular cells seems to play a pivotal role in the modulation of tubular cell growth, while monocyte chemotactic peptide-1 (MCP-1) is a powerful and specific chemotactic and activating factor for monocytes. Twenty-four patients with congenital ureteropelvic junction obstruction [UPJO; 10 with recurrent urinary tract infection (UTI) and 10 with no UTI] and 15 healthy children were studied. Diagnosis was made by renal ultrasound, intravenous pielography, and MAG3 scan. Urinary samples were collected before and after surgery. In 10 patients, urine was also collected directly from the affected pelvis at the time of surgery. Urinary EGF and MCP-1 levels were measured by enzyme-linked immunosorbent assay. MCP-1 and EGF gene expression were evaluated by in situ hybridization in 15 biopsies from congenital UPJO and in 10 normal kidneys. In normal kidneys, there was a high expression of EGF mRNA, whereas MCP-1 mRNA was undetectable. MCP-1 gene expression was strikingly increased at the tubulointerstitial level in UPJO biopsies compared with controls and was directly correlated with the extent of monocyte infiltration. In addition, UPJO kidney sections showed a marked reduction in EGF gene expression that was directly correlated with the degree of tubular damage. EGF urine concentration was significantly reduced in UPJO when compared with control and directly correlated with its renal gene expression. On the other hand, the MCP-1 urine concentration was strikingly increased in UPJO patients. It is noteworthy that a significant and inverse correlation was observed between the MCP-1 concentration in the urine collected from the obstructed pelvis and the MAG3 clearance of the obstructed kidney (r = -0.76). The presence of recurrent UTI was associated with a significantly higher MCP-1 excretion and a slight reduction in EGF urine concentration. The surgical correction of UPJO was followed by an improvement of renal function together with a significant reduction in MCP-1 excretion and a marked increase in EGF urine concentrations. Interestingly, EGF urine concentration measured before surgery was significantly correlated with the difference between the MAG3 clearance of the obstructed kidney before and after surgery. MCP-1 and EGF seem to be involved in the pathogenesis of tubulointerstitial damage in congenital obstructive nephropathy, and their urine excretion may represent a powerful prognostic marker in this form of renal disease.

Effect of Increased Intrareservoir Pressure on Upper Urinary Tract Function in Continent Urinary Diversion PatientsAssessed by Radioisotope Renography

To assess upper urinary tract function and determine an ideal continent reservoir capacity, we investigated the relationship between intrareservoir pressure and functional parameters using radioisotope renography. Forty-three patients for whom ileal reservoir construction was performed by Kock pouch (n = 33) or Hautmann’s ileal neobladder (n = 14) approaches between November 1984 and September 1996 were studied. After the reservoir contents were catheterized, ^99mTc-MAG 3 renoscintigraphy was carried out and time activity curves in the kidney (renogram) and reservoir (reservoirgram) were recorded, while saline solution was poured into the reservoir for monitoring of intrareservoir pressure. Three basic abnormal curves were noted in the excretory phase on renograms: a normal downward curve followed by an upward curve, a continuous upward curve associated with or without a sharp decline after the catheterization of the reservoir contents, and episodes of spike waves. Based on these curves, renograms were classified into five types: normal, high pressure, retention, obstruction, and reflux. Abnormal types were noted with 51 of 65 renal units (78.5%) in the Kock pouch group and 15 of 25 renal units (60.0%) in the neobladder group. This examination method may be useful for evaluating urodynamics in the upper urinary tract of patients with a continent ileal reservoir and provide data on adequate voiding volumes for the individual patient.

Is the conservative management of ureteric calculi of > 4 mm safe?

To determine the safety of the conservative management of ureteric calculi of > 4 mm in diameter, using mercapto-acetyltriglycine (MAG3) radioisotope renography to monitor renal parenchymal function. Patients with symptomatic unilateral ureteric calculi were recruited prospectively. After confirming the position of the stone using contrast urography, a MAG3 radioisotope renogram was taken within 48 h of admission and again 1 month after the patients became stone-free. The indications for intervention were ipsilateral loss of function (>/= 5% loss), infection, pain or any combination of these factors. The recovery of function was determined by follow-up renography. In all, 54 patients were recruited; 18 were initially allocated to conservative treatment although four later required intervention for pain. The remainder required early intervention for pain (eight), diminished function only (15) or diminished function with infection (13). Of the 54 patients, 28% had 'silent' loss of renal function at presentation. No calculi of > 7 mm diameter passed without intervention. The mode of initial management was determined according to individual clinical need. The upper tracts of all patients were relieved of obstruction and all patients were rendered stone-free. Intervention for reduced function only (at </= 7 days) gave a significantly better (P = 0.03) recovery of function than those undergoing later intervention. The combination of reduced function and infection were unrelated to outcome after intervention. The conservative management of stones of 5-7 mm diameter is safe, providing that radioisotope renography is used to identify those renal units requiring intervention. This approach allows timely intervention to maximize the recovery of renal function.

Surgical complications after renal transplantation in a living-related transplantation program at SIUT

Between November 1985 and November 1998, 647 renal transplants were performed at Sindh Institute of Urology and Transplantation (SIUT), Karachi. Records of all cases were reviewed and retrospective data were analysed for complications after transplantation. Diagnosis was based on ultrasound, diethylene triamine penta-acetic acid (DTPA scan), and in later years colour doppler imaging (CDI), percutaneous nephrostomy, and antegrade urographic studies. For early vascular complications immediate exploration was done, ureteric fistula and leakage were treated by exploration and reimplantation of ureter, Boari flap, and pyelovesical anastomosis.

Tc-99m MAG3 evaluation of recipients with dual adult cadaveric renal allografts. Simultaneous transplantation of both kidneys from marginal donors.

The application of Tc-99m mercaptoacetyl triglycine (MAG3) renal scintigraphy in patients who had simultaneous unilateral retroperitoneal transplant of both kidneys from marginal adult cadaveric donors is assessed. Eighteen patients who had this unusual form of kidney transplant were monitored and evaluated by Tc-99m MAG3 renal scintigraphy. More than 60 of the radioisotopic studies, including immediate postoperative and subsequent follow-up examinations, were performed among these patients. In all the studies, the two transplanted kidneys were not equally well visualized by this scintigraphic procedure because of the inherent difference in their depth from the body surface, a feature of this particular surgical design. Despite this limitation, the efficacy of the scintigraphic procedure for such dual renal allografts appears to be similar to that established for kidney transplants performed in the conventional manner. To use the scintigraphic procedure effectively, certain sensible and logical adjustments are needed for the comparative visual and semiquantitative assessments of the two kidneys in this special form of transplantation.

Fungal Bezoars as a Cause of Renal Insufficiency in Neonates and Infants-Recommended Treatment Strategy

No AccessJournal of UrologyUrological Survey: Abstracts: Pediatric Urology1 Jan 1999Fungal Bezoars as a Cause of Renal Insufficiency in Neonates and Infants-Recommended Treatment Strategy D. Visser, L. Monnens, W. Feitz, and B. Semmekrot D. VisserD. Visser More articles by this author , L. MonnensL. Monnens More articles by this author , W. FeitzW. Feitz More articles by this author , and B. SemmekrotB. Semmekrot More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)62176-1AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Fungal Bezoars as a Cause of Renal Insufficiency in Neonates and Infants-Recommended Treatment Strategy." The Journal of Urology, 161(1), p. 368 Departments of Pediatrics and Pediatric Urology, University Hospital Nijmegen, The Netherlands© 1999 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 161Issue 1January 1999Page: 368 Advertisement Copyright & Permissions© 1999 by American Urological Association, Inc.MetricsAuthor Information D. Visser More articles by this author L. Monnens More articles by this author W. Feitz More articles by this author B. Semmekrot More articles by this author Expand All Advertisement PDF downloadLoading ...

Fungal Bezoars as a Cause of Renal Insufficiency in Neonates and Infants-Recommended Treatment Strategy

Fungal bezoars may be a cause of urinary tract obstruction and acute renal failure in neonates and young infants. We describe a female very low birth weight infant (25+3 weeks, 795 gram) who developed renal insufficiency on the basis of systemic fungal infection with fungal bezoars in both kidneys. The girl was treated by local irrigation of the kidneys and bladder with amphotericin B via percutaneously inserted bilateral nephrostomy catheters, in combination with intravenous fluconazol. Renal function subsequently improved and after 11 weeks of treatment the bezoars had disappeared sonographically. Follow-up of this child and the one we similarly treated for fungal bezoars before, however, shows suboptimal renal function as assessed by the clearance of creatinine and the mercapto acetyl triglycine scan (MAG III). Until now, insufficient data are available yet to assess with certainly the long-term effects of fungal bezoars on renal function. Based on our experience and a review of the recent literature (1980-1996) on systemic candidal infections in premature infants, we recommend to perform regular renal ultrasound in any case of systemic candidal infection in a prematurely born infant. If candidal bezoars are found with pelvic obstruction, we suggest to start treatment by the insertion of bilateral nephrostomy catheters and local irrigation with amphotericin B in combination with systemic antifungal agents, aiming at both the restoration of renal function and the eradication of the fungal infection.