Renal Scintigraphy Research Articles

Laparoscopic retroperitoneal heminephrectomy for renal cell carcinoma in horseshoe kidney: a case report and review of the literature

IntroductionIn this case report, we demonstrate our technique of a retroperitoneal laparoscopic heminephrectomy for a T1b right hilar tumor in a horseshoe kidney.Case presentationA 77-year-old Vietnamese woman presented to the hospital because of right flank pain. On presentation, her serum creatinine was 0.86 mg/dL and glomerular filtration rate was 65.2 mL/minute/1.73 m2. According to her renal scintigraphy, glomerular filtration rates of the right and left moieties were 24.2 and 35.5 mL/minute, respectively. Computed tomography imaging demonstrated a 5.5 × 5.0 cm solid hilar mass with a cT1bN0M0 tumor stage was in the right moiety. After discussion, the patient elected a minimally invasive surgery to treat her malignancy. The patient was placed in a flank position. We used Gaur’s balloon technique to create the retroperitoneal working space, and four trocar ports were planned for operation. Three arteries were dissected, including two arteries feeding the right moiety, one artery feeding the isthmus, and one vein, which was clipped and divided by Hem-o-lok. The isthmusectomy was performed with an Endostapler. Consequently, the ureter was clipped and divided. Finally, the whole right segment of the horseshoe kidney was mobilized and taken out via the flank incision.ResultsThe total operative time was 250 min with an estimated blood loss of 200 mL. The patient's serum creatinine after surgery was 1.08 mg/dL, and glomerular filtration rate was 49.47 mL/minute/1.73 m2. The patient was discharged on postoperative day #4 without complication. Final pathologic examination of the tumor specimen revealed a Fuhrman grade II clear cell renal cell carcinoma, capsular invasion, with negative surgical margins. After a three-month follow-up, the serum creatinine was 0.95 mg/dL, and glomerular filtration rate was 57.7 mL/minute/1.73 m2. Local recurrence or metastasis was not detected by follow-up computed tomography imaging.ConclusionsRetroperitoneal laparoscopic heminephrectomy is a safe and feasible technique for patients with renal cell carcinoma in a horseshoe kidney and may be particularly useful in low income settings without access to robotic technology.

Decline in measured glomerular filtration rate is associated with simple renal cyst in Chinese patients with type 2 diabetes.

Simple renal cysts (SRC) are associated with age, hypertension and hyperuricemia, which are risk factors of renal impairment. This study aimed to investigate the prevalence of SRC and its association with measured glomerular filtration rate (mGFR) in patients with type 2 diabetes mellitus in China. A total of 3,552 patients with type 2 diabetes mellitus admitted to Shanghai Sixth People's Hospital from January 2012 to December 2016 were investigated. All participants were diagnosed as SRC by color Doppler, and all participants were measured for GFR by using dynamic renal scintigraphy with technetium-99m-diethylene triamine peta-acetic acid. The prevalence of SRC was 17.4% (619 cases). Participants with SRC had significantly lower mGFR values than those without SRC (86.16 ± 26.20 vs 94.88 ± 23.98 mL/min/1.73 m2 , P < 0.001). In 478 participants with unilateral renal cyst, the mGFR of the kidney affected by SRC was significantly lower than that of the unaffected kidney (43.32 ± 13.74 vs 44.18 ± 13.34 mL/min/1.73 m2 , P = 0.014). The participants were divided into four groups according to the quartiles of mGFR level (≥109.50, 93.80-109.49, 76.90-93.79 and <76.90 mL/min/1.73 m2 ). The prevalence of SRC gradually increased with decreasing mGFR level (12.9, 13.9, 16.6 and 27.8%, respectively; P trend <0.01). After adjusting for age, sex, duration of diabetes, hypertension and other potential confounders, the logistic regression showed that SRC was an independent risk factor for impaired GFR (<60 mL/min/1.73 m2 ; odds ratio 1.656; 95% confidence interval 1.451-1.890, P < 0.001). SRC is an independent risk factor for the decrease of mGFR in Chinese diabetes patients, and could affect the renal GFR measured by dynamic renal scintigraphy on the SRC side.

Computed Tomography Renal Volumetry Better Predicts Postoperative Donor Renal Function in Live Kidney Donor Transplantation than Renal Scintigraphy: A Comparative Study

Introduction and Objectives: Both computed tomography (CT) and renal scintigraphy (RS) have been used to assess vascular anatomy, renal status, and split renal function (SRF). In this study, we used a recently developed software that facilitates renal volumetric evaluations to compare RS and automated CT volumetry for assessing residual renal function and, thus, estimating postoperative renal function after donor nephrectomy. Methods: Fifty-one cases of donor nephrectomy were analyzed. Residual renal function was estimated based on RS and CT volumetry. The correlation between the postoperative estimated glomerular filtration rate (eGFR) and expected SRF, measured using RS and three types of CT volumetry data (ellipsoid, thin-slice, and 5-mm slice data), was determined. Results: The correlation coefficient between actual eGFR and expected SRF was significantly associated at each time point and modality (p < 0.0001). At any time point, the difference in correlation coefficient between RS and 5-mm volumetry was significant (p value: 0.003–0.018), whereas the differences in correlation coefficients between RS and the triaxial volume calculation, and the triaxial volume calculation and 5-mm volumetry, were generally statistically insignificant. Conclusions: Expected SRF was estimated more accurately by CT volumetric calculations (especially 5-mm slice-based volumetry) than RS.

Non-contrast-enhanced magnetic resonance urography for measuring split kidney function in pediatric patients with hydronephrosis: comparison with renal scintigraphy.

Split kidney function (SKF) is critical for treatment decision in pediatric patients with hydronephrosis and is commonly measured using renal scintigraphy (RS). Non-contrast-enhanced magnetic resonance urography (NCE-MRU) is increasingly used in clinical practice. This study aimed to investigate the feasibility of using NCE-MRU as an alternative to estimate SKF in pediatric patients with hydronephrosis, compared to RS. Seventy-five pediatric patients with hydronephrosis were included in this retrospective study. All patients underwent NCE-MRU and RS within 2weeks. Kidney parenchyma volume (KPV) and texture analysis parameters were obtained from T2-weighted (T2WI) in NCE-MRU. The calculated split KPV (SKPV) percent and texture analysis parameters percent of left kidney were compared with the RS-determined SKF. SKPV showed a significant positive correlation with SKF (r = 0.88, p < 0.001), while inhomogeneity was negatively correlated with SKF (r = - 0.68, p < 0.001). The uncorrected and corrected prediction models of SKF were established using simple and multiple linear regression. Bland-Altman plots demonstrated good agreement of both predictive models. The residual sum of squares of the corrected prediction model was lower than that of the uncorrected model (0.283 vs. 0.314) but not statistically significant (p = 0.662). Subgroup analysis based on different MR machines showed correlation coefficients of 0.85, 0.95, and 0.94 between SKF and SKPV for three different scanners, respectively (p < 0.05 for all). NCE-MRU can be used as an alternative method for estimating SKF in pediatric patients with hydronephrosis when comparing with RS. Specifically, SKPV proves to be a simple and universally applicable indicator for predicting SKF.

Analysis of the Efficacy of Elastography in Comparison with Dynamic Renal Nuclear Scintigraphy in the Evaluation of Unilateral Pelvi–Ureteric Junction Obstruction

IntroductionIn hydronephrosis due to pelviureteric junction obstruction (PUJO), an obstruction to urine flow may lead to increased pelvic pressure, which may cause interstitial fibrosis and renal impairment. Recently, there have been reports on renal pelvic assessment using ultrasound elastography (USE). This study was conducted to see if USE can evaluate PUJO and if it can be correlated to the findings of the dynamic renal nuclear scan. Material and methodsIn this observational study, only patients with unilateral PUJO underwent acoustic radiation force impulse (ARFI) elastography. A rectangular region of interest (ROI) measuring 5 × 10 mm was positioned on the cortex region of the upper, mid, and lower poles of the affected kidney. Three valid measurements were obtained, from which a mean value was calculated. A dynamic renal nuclear scan using Technetium-99m ethylene dicysteine (EC or TC99 m EC) was obtained and split renal function (SRF) was used for comparison. ResultsIn the group of 20 patients, the mean age was 3.37 years. The mean SRF of the affected kidney was 26.65 %, and the corresponding USE value was 0.45 kpa. The Spearman's rho correlation coefficient for SRF and USE was 1 and 0.672, respectively (p = 0.001). Elastography was not feasible if SRF was less than 20 %. ConclusionUSE may be able to comment on the renal functional status of hydronephrosis. If USE is reported as non-feasible, it may suggest that renal function is grossly compromised. It may serve as an alternative diagnostic modality for renal functional evaluation. Level of evidenceLevel II, Prospective Cohort Study.

Clinical application of 99mTc-DTPA dynamic renal scintigraphy with consequent SPECT/CT imaging in patients with different nephrological conditions

Introduction: Dynamic renal scintigraphy with 99mTechnetium diethylenetriaminepentaacetic acid (99mTc DTPA) is a generally used imaging technique for evaluating renal function of patients with various nephro-urological conditions. Clinical application of SPECT/CT nephroscintigraphy has rarely been discussed. Objective: The aim of the study was to evaluate the added value of SPECT/CT imaging to dynamic renal scintigraphy with 99mTc DTPA. Materials and Methods: Thirty two patients (66% female and 34% male) who underwent dynamic nephroscintigraphy with subsequent SPECT/CT with mean age 55.9±18.25 years was observed. The CT scan was performed with a low dose protocol. A dose of 185MBq (5mCi) 99mTc DTPA was administered intravenously. Results: Our analysis demonstrated impaired relative renal function in various degrees of left kidney in 18 patients (56%) and of right kidney in 14 patients (44%). SPECT/CT imaging revealed the specific cause, responsible for the renal dysfunction in the cases. The hybrid imaging demonstrated urolithiasis in 11 patients, postopertative strictures of ureter in 5 patients, diagnosed urological cancer in 4 patients, external compression of ureter from ovarian cyst in 1 patient and compression of ureter due to nephroptosis in 1 patient as a possible obstructive cause. In 10 patients congenital renal anomalies were the identified causes of impaired renal function – hypoplastic kidney in 4 patients, duplex kidney in 2 patients, multiple cortical cysts in 2 patients, aberrant vessel obstructing the pyeloureteral segment in 1 patient and horseshoe kidney in 1 patient. Conclusion: The combination of conventional 99mTc DTPA dynamic renal scintigraphy with subsequent SPECT/CT could provide not only functional but also anatomical information of the urinary tract, especially in the evaluation of obstructive uropathies and congenital renal abnormalities, that can change the clinical management

Assessment of infant gonadal dose irradiated from urine-contaminated diapers during diuretic renal scintigraphy.

To estimate the gonadal doses irradiated from urine- contaminated diapers during diuretic renal scintigraphy. Images of 31 patients (18 males and 13 females) with urine-contaminated diapers during 99mTc-MAG3 renal scintigraphy were analyzed. The count rate of the diapers was converted into a time-activity curve based on the calibrated factor of the gamma camera system. The cumulative activity was determined from the area under the curve. By incorporating dose per unit cumulative activity pre-calculated from Monte Carlo simulation with 0-year phantom, the gonadal dose irradiated from diaper was calculated. To assess the degree of this additionally introduced dose from diapers, the calculated gonadal dose was compared to the internal gonadal dose from injected radiotracer activity. The cumulative activities irradiated from urine-contaminated diapers were 1.12 E04 ± 1.29E04 MBq.s in male infants, which was nearly half of the 1.94 E04 ± 1.80E04 MBq.s (P = 0.15) in female infants. However, the absorbed doses for testes in male infants were 7.37E-01 ± 8.50E-01 mGy, which was approximately 10 times the 6.38E-02 ± 5.94E-02 mGy for ovaries in female infants (P < 0.01). The diaper-introduced dose for testes and ovaries was 91.7% and 3.9% of the gonadal doses from the injected activity in patients with normal renal function, and 99.0% and 4.3% of those in patients with abnormal renal function. Urine-contaminated diapers introduced additional radiation doses to infant patients during 99mTc-MAG3 renal scintigraphy. The gonadal doses were of significance in male infants who had nearly double the absorbed dose for the testes.

Voiding Sistoüretrogram ile Tanı Konulan Vezikoüreteral Reflü'nün Saptanmasında Dinamik Böbrek Sintigrafisinin Rolü

Aims: This study aims to evaluate the role of standardized dynamic renal scintigraphy (DRS) in recognizing vesicoureteral reflux (VUR) in patients detected with VUR by voiding cystourethrography (VCUG). Methods: The data of all pediatric patients who underwent both VCUG and DRS [technetium-99m diethylenetriamine pentaacetic acid (Tc-99m DTPA) or technetium-99m mercaptoacetyltriglycine dynamic renal scintigraphy (Tc-99m MAG-3)] in our hospital between 2013 and 2022 were retrospectively reviewed. Tc-99m MAG-3 was used in infants and Tc-99m DTPA radiopharmaceutical in children over one year old. According to VCUG findings, VUR grades were grouped as grade I-II-III low-grade VUR and IV-V high-grade VUR. The role of DRS in detecting VUR in both low and high-VUR-grade groups was evaluated. Results: A total of 56 patients (and 69 renal units), 23 girls (%41.1), and 33 boys (%68.9) were included in this study. The median value of the time elapsed between the DRS and VCUG examinations was nine days. According to VCUG, VUR was grade I in five renal units, grade II in 19 renal units, grade III in six renal units, grade IV in six renal units, and grade V in 33 renal units. DRS detected VUR in two of 30 renal units (%6.7) in the low VUR grade group. On the other hand, VUR was observed with DRS in 27 of 39 renal units (%69.2) in the high VUR grade group. Conclusions: Standardized DRS shows very low sensitivity in recognizing low-grade VUR, and its performance in detecting high-grade VUR is comparatively better. Raising awareness among clinicians that VUR can be observed with standardized DRS will benefit the patient in terms of early detection of accompanying VUR pathologies.

Complete Remission of Renal Scarring in Follow-Up DMSA Renal Scintigraphy After Urinary Tract Infection.

Our study aimed to investigate the association between the characteristics of patients/images and complete remission of renal scarring shown in the first chronic phase Technetium-99m dimercaptosuccinic acid (DMSA) renal scintigraphy images in children with urinary tract infection (UTI). Fifty children, who underwent the chronic phase of DMSA scintigraphy more than twice following UTI diagnosis and had renal scarring in the first chronic phase DMSA renal scintigraphy, were enrolled. They were classified into 2 groups: with and without complete remission of renal scarring on the second chronic phase DMSA renal scintigraphy. Renal scarring was classified into 3 grades based on severity per the image findings. Seven cases had complete remission from renal scarring. There were significant differences in age and severity. Renal scarring might be completely reversed in young children without severe findings on DMSA renal scintigraphy. Additional chronic phase examination may aid in follow-up completion and patients' peace of mind.

Real-time estimation of nephron activity with a linear measurement system (RENAL-MS) predicts postoperative estimated glomerular filtration rate.

To determine whether a simple point-of-care measurement system estimating renal parenchymal volume using tools ubiquitously available could be used to replace nuclear medicine renal scintigraphy (NMRS) in current clinical practice to predict estimated glomerular filtration rate (eGFR) after nephrectomy by estimating preoperative split renal function. We performed a retrospective review of patients who underwent abdominal cross-sectional imaging (computed tomography/magnetic resonance imaging) and mercaptoacetyltriglycine (MAG3) NMRS prior to total nephrectomy at a single institution. We developed the real-time estimation of nephron activity with a linear measurement system (RENAL-MS) method of estimating postoperative renal function via the following technique: renal parenchymal volume of the removed kidney relative to the remaining kidney was estimated as the product of renal length and the average of six renal parenchymal thickness measurements. The utility of this value was compared to the utility of the split renal function measured by MAG3 for prediction of eGFR and new onset Stage 3 chronic kidney disease (CKD) at ≥90 days after nephrectomy using uni- and multivariate linear and logistic regression. A total of 57 patients met the study criteria. The median (interquartile range [IQR]) age was 69 (61-80) years. The median (IQR) pre- and postoperative eGFR was 74 (IQR 58-90) and 46 (35-62) mL/min/1.73 m2 , respectively. [Correction added on 29 December 2023, after first online publication: The data numbers in the preceding sentence have been corrected.] Correlations between actual and predicted postoperative eGFR were similar whether the RENAL-MS or NMRS methods were used, with correlation using RENAL-MS being slightly numerically but not statistically superior (R = 0.82 and 0.76; P = 0.138). Receiver operating characteristic curve analysis using logistic regression estimates incorporating age, sex, and preoperative creatinine to predict postoperative Stage 3 CKD were similar between RENAL-MS and NMRS (area under the curve 0.93 vs. 0.97). [Correction added on 29 December 2023, after first online publication: The data numbers in the preceding sentence have been corrected.] CONCLUSION: A point-of-care tool to estimate renal parenchymal volume (RENAL-MS) performed equally as well as NMRS to predict postoperative eGFR and de novo Stage 3 CKD after nephrectomy in our population, suggesting NMRS may not be necessary in this setting.

Scinтigraphy in Children with Urinary Tract Dilatation (Antenatally Detected Hydronephrosis)

The causes of Antenatal Hydronephrosis/Urinary Tract Dilatation (ANH/UTD) vary from transient benign conditions-transit hydronephrosis, (resolves by birth or during infancy) to conditions that can significantly affect renal function. The outcome of depends on the underlying etiology, so it is very important to determine these causes. The definition and grading of ANH is based on the Anteroposterior Pelvic Diameter (APD) of the fetal renal pelvis. Antenatal management includes antenatal ultrasound monitoring, which is usually repeated every 4-6 weeks. It is recommended that the assessment of the severity of postnatal hydronephrosis is based on the APD of the renal pelvis. Extensive postnatal investigation was proposed to be limited to those with moderate or severe dilatation. Voiding cystourethrography and scintigraphy are usually preserved for children with postnatal APD &lt;15 mm and/or abnormal kidney parenchyma, severe caliyx dilatation ureteral dilatation and bladder pathology. Diuretic renal scintigraphy is important in the postnatal evaluation of infants with ANH, particularly in distinguishing kidneys with poor drainage from nonobstructive hydronephrosis with good drainage. According to our diuretic renography results, we conclude that in the presence of partial or no drainage, the separate renal function may not be significantly impaired. The finding of poor renal emptying is significantly more common among children with increasing renal pelvis APD. Technetium 99m-dimercaptosuccinic acid renal scintigraphy (99mTc-DMSA) has been used in renal imaging to estimate the functional renal mass (damage to the kidney) and relative renal function, especially in pediatric patients. A statistically significant correlation between the degree of hydronephrosis (APD) and DMSA scan finding and between the degree of the VUR and DMSA scan finding was established. Other than VUR, CAKUT (pelvic ureteric junction obstruction, pyelon et ureter duplex, megaureter, posterior urethra valves) were not statistically correlated with pathological findings on the DMSA scan.

EP12.01: How well do we predict renal dysplasia? Comparison between prenatal ultrasound and postnatal renal scintigraphy in CAKUT

EP12.01: How well do we predict renal dysplasia? Comparison between prenatal ultrasound and postnatal renal scintigraphy in CAKUT

Motorcycle trauma unveiling massive pyeloureteral junction syndrome

This medical case study presents a rare and intriguing incidentally discovered junctional syndrome in a 36-year-old male involved in a motorcycle accident. A subsequent CT scan revealed a massive pyelocalyceal dilatation measuring 22 cm with a 12 cm-diameter pyelon, compressing the renal parenchyma (Fig1,Fig2). Remarkably, despite the extensive dilation, the patient's renal function remained unaffected, as indicated by normal laboratory findings. Prompt management involved right-side JJ stenting (Fig3,Fig4) and renal scintigraphy, which revealed that the right kidney contributed only 20% of the total renal function. This exceptional presentation highlights the significance of early detection and intervention in such cases to optimize renal health and prevent potential complications. Long-term monitoring is essential to ensure the well-being of the patient and manage this rare medical condition effectively.

Advantages of multi-target scintigraphy in the diagnosis of kidney cancer

Background. There has been a recent increase in the incidence of kidney cancer, which is explained not only by the improvement in the diagnosis of neoplasms but also by a true increase in the incidence of renal cell cancer. This led to the need for in-depth study and solution of the following problem: to prove the benefits of multi-target scintigraphy for the assessment of the functional capacity of kidneys in establishing the diagnosis of kidney cancer and early detection of secondary lesion of the skeleton during the primary full examination of the patient, as well as in monitoring of the disease.&#x0D; Purpose. For the first time to prove diagnostic significance of a multi-target scintigraphic examination with a radiopharmaceutical drug with renal and osteotropic kinetics, in the form of a sequential combination of dynamic renal scintigraphy and osteoscintigraphy (as one diagnostic examination) in the early detection of secondary lesion of the bones of the skeleton and simultaneous determination of the functional capacity of kidneys in the pre-treatment period and in monitoring of the course of kidney cancer.&#x0D; Materials and methods. Dynamic renal scintigraphy and subsequent (within the next 3 hours) osteoscintigraphy with 99mTc-methylenediphosphonic acid (99mТс-MDP) (activity of 370–740 MBq) were performed on the SPECT-1 gamma camera «AMCRIS-H Limited» (Ukrainian-American enterprise) with computer software «Spect Work» (Ukraine) at the premises of the Department of Radiology and Radiation Medicine of Bogomolets National Medical University in the Department of Radionuclide Diagnostics of communal non-commercial enterprise&#x0D; «Kyiv City Clinical Hospital No.18». 20 patients with a morphologically established diagnosis of kidney cancer, aged from 38 to 68 years, were examined before the full diagnosis was established according to TNMx. As a control group, 8 patients with ultrasonography-confirmed cystic lesions of the kidneys were examined.&#x0D; Results. Using a radiopharmaceutical drug with renal and osteotropic kinetics in the form of a simultaneous sequential combination of dynamic renal scintigraphy and osteoscintigraphy (as one diagnostic examination) allowed us to assess the degree of deterioration of the filtering and excretory capacity of the kidneys regardless of the origin of the expansive process. The results of dynamic renal scintigraphy with 99mТс-MDP made it possible to assess functional capacity of the kidneys no worse than specific renal imaging agents in subsequently given possibility to determine secondary lesion of the bones of the skeleton in osteoscintigraphy. We established indicators of development of renal compensation process and subsequent decompensation process of the contralateral kidney. It was especially noticeable when analyzing the asymmetry of the fixation of the radiopharmaceutical in the functioning kidney parenchyma, depending on the degree of the disease progression.&#x0D; 20 patients with kidney cancer underwent osteoscintigraphy for the complete diagnosis to be established according to TNM. The following changes were detected: the presence of heterogeneous focal (17,8% of the cases) and multifocal (7,1% of the cases) distribution of the radiopharmaceutical.&#x0D; Conclusions. Performing a multi-target scintigraphy with 99mТс-MDP (phosphates) in malignant process in the kidney allows the functional capacity of the kidneys and the presence of the secondary lesion of the bones to be assessed in one exami- nation. Besides reducing radiation burden on the patient (one examination instead of two), it is also economically beneficial.

Kronik Piyelonefritin Nadir Bir Nedeni: Ksantogranulomatöz Piyelonefrit

Xanthogranulomatous pyelonephritis (XGP) is a chronic, destructive, granulomatous inflammation of the renal parenchyma leading non-functioning kidney. Contrast-enhanced computed tomography is the most useful diagnostic method. A 6-year-old female patient admitted to us with complaints of abdominal pain, fever, fatigue, weakness. Recurrent urinary tract infection was present in her history. The patient’s urine specimen revealed leukocyturia, hematuria, positive for nitrite and bacteria, white blood cell: 12.7x103 /microl, hemoglobin:6.2 g/dl and CRP: 101 mg/dl. In the urinary system USG imaging, the contours of the left kidney were irregular and lobulated, and medullary punctate echogenicity and calcifications were present. Contrast-enhanced abdominal computed tomography showed increased left kidney size and opacities suggestive of stone in the collecting system; pararenal area was heterogeneous. Although the patient's gentamicin treatment was completed in 7 days and meropenem treatment in 14 days, acute phase reactants did not regress. No activity uptake was observed in the left kidney lodge in renal cortical scintigraphy. Left total nephrectomy was performed with the diagnosis of non-functioning left kidney and chronic pyelonephritis. Kidney biopsy material were reported as XGP. XGP is a rare and aggressive cause of chronic pyelonephritis with serious consequences such as nephrectomy requirement.

Clinical Value of the Combination Detection of Captopril Renal Scintigraphy and Plasma Renin Activity in the Diagnosis of Renal Hypertension.

This study aimed to investigate the clinical value of the combination detection of captopril renal scintigraphy (CRS) and plasma renin activity (PRA) in the diagnosis of renal hypertension (RHR). Retrospective analysis was conducted on the clinical data of 163 patients with suspected RHR admitted to our hospital from March 2019 to March 2021, and all patients underwent blood pressure, CRS and digital subtraction angiography (DSA). The patients were divided into the positive group (n = 100) and the negative group (n = 63) in accordance with the results of DSA examination. PRA, angiotensin II and aldosterone levels of the two groups were detected and compared. The receiver operating characteristic curve was used to analyse the CRS, PRA and combined diagnostic performance. The uptake ratio value after captopril intervention in the positive group was 36.71% ± 8.79%, which was significantly lower than that in the negative group (56.79% ± 10.09%, p < 0.05). The serum PRA level of the positive group was 4.70 ± 1.67 ng/mLꞏh, which was distinctly higher than that of the negative group (2.12 ± 1.03 ng/mLꞏh, p < 0.05). The sensitivity and Youden index under the combination detection (area under the curve (AUC) = 0.956, p < 0.001) were all higher than those under single detection. The combined detection of PRA and CRS can provide considerable evidence for the early diagnosis and treatment of RHR, which has a certain clinical value.

Successful rescue pneumovesicoscopic surgery for post-Deflux® vesicoureteral junction obstruction.

Vesicoureteral junction (VUJ) obstruction after Deflux® subureteral injection for vesicoureteral reflux (VUR) is rare and minimally invasive management has not been reported. This work investigated the patients who underwent Deflux® injection for VUR and identified those with subsequent VUJ obstruction. Medical records of matched patients from October 2003 to March 2022 were reviewed, and parameters were retrospectively studied. All patients underwent Deflux® injection. The injection was performed under general anesthesia using the same manner. For patients complicated with VUJ obstruction, the symptoms, signs, management, images, renal ultrasounds, Tc-99m dimercaptosuccinic acid renal scintigraphy, histology of VUJ region, and outcomes were documented and reported. VUJ stenosis was diagnosed by performing renal ultrasound and magnetic resonance imaging. Totally 407 patients (554 ureterorenal units) received Dx/HA injections for VUR. VUJ obstruction was found in three patients (four ureterorenal units). Originally, three were grade V VUR, and one was grade IV. The repeated injection was not a risk factor for VUJ obstruction. The overall incidence of VUJ obstruction post-Dx/HA injection was 0.7% by ureter. The incidences were 0%, 0.75%, and 2.25% for grade I-III, IV, and V VUR, respectively. After the initial conversion case of pneumovesicoscopic ureteral reimplantation, the procedure was performed smoothly and successfully in the two following cases. Pneumovesicoscopic ureteral reimplantation offers an alternative for VUJ obstruction following Dx/HA injection for VUR. Fibrosis and foreign-body reaction may influence the feasibility. High-grade VUR and young age of injection were related to VUJ obstruction.

Effect of left renal vein compression stenosis on functional status of left kidney in patients with pelvic venous disorders

ObjectiveWe evaluated the effect of left renal vein (LRV) compression stenosis on the functional state of the left kidney in patients with pelvic venous disorders (PeVDs). MethodsWe examined 162 female patients with PeVD and diagnosed LVR compression stenosis using duplex ultrasound (DUS) in 40. Patients with clinical manifestations of PeVD (n = 26) had symptoms and signs of pelvic venous congestion but without pain in the left flank of the abdomen, typical for nutcracker syndrome (NS). The remaining patients were asymptomatic (n = 14). The parameters measured with DUS included the angle of the superior mesenteric artery (SMA) with the aorta, the LRV diameter (Dhilum/Dstenosis) ratio, and LRV velocity (Vstenosis/Vhilum) ratio. All the patients underwent laboratory testing (complete blood count, urinalysis, and biochemical blood testing) and dynamic renal scintigraphy to assess the secretory and evacuation functions of the renal tubular system. ResultsThe laboratory tests revealed no abnormalities, including no hematuria or proteinuria, in either group. The Dhilum/Dstenosis and Vstenosis/Vhilum ratios varied from 2.8 to 5.2 and from 2.9 to 8.3, respectively, and did not differ between the symptomatic and asymptomatic patients. All 40 patients with LRV compression stenosis were diagnosed with left gonadal vein reflux with a mean duration of 4.7 ± 0.6 seconds and 2.2 ± 0.6 seconds in the symptomatic and asymptomatic patients, respectively (P = .005). Eight patients had signs of NS on DUS, including five in the symptomatic group (SMA angle, 34.8° ± 2.7°; Dhilum/Dstenosis ratio, 5.2 ± 0.2; and Vstenosis/Vhilum ratio, 5.7 ± 0.4) and three in the asymptomatic group (SMA angle, 35° ± 2.8°; Dhilum/Dstenosis ratio, 5; and Vstenosis/Vhilum ratio, 5 ± 0.5). The groups did not differ significantly in the DUS parameters. Scintigraphy did not reveal any cases of secretory or evacuation dysfunction of the left kidney, including in the patients with DUS signs of NS. The maximum uptake time, elimination half-life, and effective renal plasma flow were within the normal ranges. ConclusionsLRV compression stenosis without hematuria has no significant effects on the functional state of the left kidney, irrespective of the disease severity. In patients with PeVDs, dynamic renal scintigraphy provides an objective assessment of left kidney function.

Interest of renal scintigraphy with captopril in the diagnosis of renovascular arterial hypertension

Introduction: Renal scintigraphy with captopril test of the kidney is a simple, non-invasive functional imaging technique that can be used to demonstrate the role of stenosis in the development of renovascular hypertension (RVH). It also makes it possible to distinguish renal artery stenosis responsible for RVH from stenosis associated with primary arterial hypertension. Objective: To illustrate the benefits of renal scintigraphy with captopril test in the diagnosis of RVH. Material and method: This was a prospective and descriptive study over a period of 12 months, from 1 March 2016 to 4 March 2017, carried out in the nuclear medicine department of the Institut des Radio Isotopes (IRI) in Niamey. The parameters studied were age, frequency, creatinemia, tracer used, relative perfusion, relative renal function and maximum uptake time. Results: We collected 6 cases presenting with either hypertension refractory to well-administered two- or three- therapy, or severe hypertension at the complication stage, or hypertension associated with hypokalaemia or unexplained renal failure or reversible renal failure induced by a conversion enzyme inhibitor. The mean age was 35 years. The age of diagnosis of hypertension ranged from 20 to 28 years. Four patients underwent echodoppler of the renal arteries: unilateral stenosis in patients A, C and F, and bilateral stenosis in patient D. The captopril test was positive in 3 cases, patients A, B and C. Conclusion: Dynamic renal scintigraphy with captopril testing is a non-invasive, low-radiation diagnostic method for the investigation of renovascular hypertension. It has a triple benefit, including the detection of the most severe arterial stenoses, the prediction of the curability of the stenosis by a revascularisation procedure and, finally, post-treatment follow-up.

Ambulatory Management of Urinary Tract Infections in Children: Experience of the Pediatric Medical Emergency Department in Rabat

The aim of the study is to describe the clinical epidemiological characteristics and bacteriological profile of UTIs in infants and children, to determine the main risk factors for the occurrence of UTIs, and to identify the causes of UTIs urinary tract infections, to compare the interest of CRP and let procalcitonin assays for the diagnosis of febrile urinary tract infections as well as the interest of imaging (renal scintigraphy and ultrasound of the urinary tree) in the diagnosis of febrile urinary tract infections. This observational study of a cohort of 169 patients (children aged more than 28 days, 119 girls and 40 boys) conducted in the pediatric emergency department of the children's hospital of the university hospital of Rabat over a period of 6 months. The diagnosis of UTIs is based on the detection of germs in the urine, either indirectly by urine dipstick or by urine culture. However, the interpretation of microbiological results can be tricky: an inappropriate urine collection technique, particularly in neonates and young children, is a pitfall that the clinician must take into account to avoid misdiagnosing UTI, usually by over-diagnosis. The location of high UTI involving the renal parenchyma or low UTI limited to the bladder, which determines the morbidity of the infection, the therapeutic management and the imaging work-up, remains a matter of debate. DMSA renal scintigraphy, the reference examination in the case of high UTI, cannot be recommended as a first-line examination because of its cost and the practical difficulties of performing it. Biological markers of inflammation (leucocytosis, CRP, procalcitonin) do not always allow the diagnosis of ANP to be made with certainty.