Assessment of renal parenchymal changes using isotope renography for genitourinary indications in pediatric age group-a study of 47 cases
Abstract
Background: With the introduction of isotope renography using DMSA (Dimercaptosuccinic acid), more stress than ever has been put on the evaluation of renal parenchyma in a morphologically normal but injured kidney.
Objective: To study the pattern of renal dysfunction and anomalies noted after isotope renography using DMSA.
Materials and methods: A retrospective study was conducted at department of Paediatrics of Amala Institute of Medical Sciences, Thrissur after evaluating the hospital records involving children undergoing isotope renography using DMSA (IRDMSA) for genitourinary indications between August 1st 2012 and August 1st 2013.
Results: The common indications for IRDMSA were found to be urinary tract infections (UTI) (61.7%), multicystic dysplastic kidneys (MCDK) (12.7%), posterior urethral valve (PUV) (6.3%) and unilateral hydronephrosis (6.3%). Among the UTI group, 10.7% had the evidence of bilateral renal scarring and 42.8% unilateral renal scarring. Only 32.1% had bilaterally normal kidneys. Analysis of 7 cases with significantly reduced differential function (DF< 30/70) showed associated vesicoureteral reflux (VUR) in 100% cases. A male predominance was noticed even though only one case had posterior urethral valve. Right kidney was found to be more susceptible than the left. A study of the scar topography showed majority to be localized to the upper pole and superolateral border. 100% of the MCDKs were found to be non-functional and was not visualized in the renogram.
Conclusion: IRDMSA is a reliable imaging modality in the follow up of acute pyelonephritis in children, detecting structural abnormalities and also for identifying kidneys in children at risk for subsequent renal scarring.
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