RESUMEN
Blood groups ABO, MN, Rhesus, P, and Lewis, salivary ABH secretion, and at the HLA DQ alpha locus were studied in 65 Caucasian children of both sexes diagnosed as having acute febrile urinary tract infection in the 1st year of life, as well as in 60 Caucasian control children. No differences were observed between patients and controls. Results from patients with normal urinary tracts were also similar to those from patients with primary vesicoureteral reflux. We could not confirm previous findings suggesting different susceptibility to urinary tract infection based on phenotypes of several genetic markers.
Asunto(s)
Infecciones Urinarias/genética , Enfermedad Aguda , Antígenos de Grupos Sanguíneos , Femenino , Fiebre/etiología , Marcadores Genéticos , Genotipo , Antígenos HLA-DQ/genética , Antígenos HLA-DQ/inmunología , Humanos , Lactante , Recién Nacido , Masculino , Fenotipo , Saliva/metabolismo , Infecciones Urinarias/complicacionesRESUMEN
The dimercaptosuccinic acid (DMSA) renal scan is a method for assessing kidney function. Indications for DMSA scanning in children with urinary tract infection (UTI), as well as timing, have changed. Pitfalls in interpreting DMSA scans include: (1) acute pyelonephritis (APN), (2) tubular dysfunction, (3) hypertension, (4) use of captopril in patients with renovascular hypertension and (5) duplex kidneys. Interpretation of DMSA scans in children with UTI vary according to timing and clinical setting. During the course of a febrile UTI a DMSA scan may reveal a normal kidney, APN or a non-functioning, small and/or ectopic kidney. In the absence of UTI (up to 6 months) in children with vesicoureteric reflux a DMSA scan may indicate a normal kidney, renal scarring (reflux nephropathy), occult duplex kidney and allows the progression of scarring and hypertrophy of normal areas of the kidney to be followed anatomically. The DMSA renal scan in now the most reliable test for the diagnosis of APN. The transient abnormalities due to APN can occur in normal or scarred kidneys. Lesions due to reflux nephropathy (defined as a defect in the renal outline or contraction of the whole kidney) are permanent. Intravenous urography reveals renal abnormalities later than the DMSA scan. If abnormalities are seen on a DMSA scan performed during the course of APN it is impossible to predict the outcome: they can progress to permanent scarring or heal completely. An abnormal DMSA scan during a febrile UTI allows the identification of children at risk of developing renal scars. These children should be carefully investigated, maintained on long-term quimioprophylaxis and followed.
Asunto(s)
Compuestos de Organotecnecio , Succímero , Infecciones Urinarias/diagnóstico por imagen , Enfermedad Aguda , Animales , Niño , Cicatriz/diagnóstico por imagen , Cicatriz/microbiología , Humanos , Inyecciones Intravenosas , Riñón/metabolismo , Riñón/patología , Enfermedades Renales/diagnóstico por imagen , Enfermedades Renales/microbiología , Compuestos de Organotecnecio/administración & dosificación , Compuestos de Organotecnecio/metabolismo , Pielonefritis/diagnóstico por imagen , Pielonefritis/microbiología , Cintigrafía , Succímero/administración & dosificación , Succímero/metabolismo , Ácido Dimercaptosuccínico de Tecnecio Tc 99m , Urografía/métodos , Reflujo Vesicoureteral/diagnóstico por imagen , Reflujo Vesicoureteral/microbiologíaRESUMEN
A total of 202 children (mean age 31.5 +/- 23.3 months) with vesicoureteral reflux identified during the investigation that follows a urinary tract infection entered this prospective study dealing with the medical management of reflux. The diagnosis of vesicoureteral reflux was made significantly earlier in boys than in girls regardless of reflux grade (p < 0.001). At entry reflux nephropathy was present on a dimercaptosuccinic acid scan in 44% of 314 refluxing kidneys. There was no significant difference between boys and girls in the prevalence of reflux nephropathy. The renal lesions were more severe in boys independently of the grade of vesicoureteral reflux (p < 0.05). Breakthrough urinary tract infection was significantly more common in girls than in boys, regardless of vesicoureteral reflux grade (p < 0.05). Mean followup was 68.7 +/- 31.2 months. Patient age at the time of the first of 2 radionuclide cystograms without vesicoureteral reflux was considered the age of spontaneous resolution of reflux. Using life table estimations and analyzing data stratified to sex and grade of vesicoureteral reflux, we found that although reflux lasted longer in boys compared to girls, this difference was not statistically significant. During followup new scars developed in 7 patients related to breakthrough urinary tract infection. There was no significant difference between boys and girls in the development of new scars. To understand the natural history of vesicoureteral reflux children must be stratified by sex and grade of reflux.
Asunto(s)
Reflujo Vesicoureteral/terapia , Niño , Preescolar , Cicatriz/epidemiología , Cicatriz/etiología , Femenino , Estudios de Seguimiento , Humanos , Lactante , Enfermedades Renales/epidemiología , Enfermedades Renales/etiología , Masculino , Prevalencia , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Infecciones Urinarias/etiología , Reflujo Vesicoureteral/clasificación , Reflujo Vesicoureteral/complicacionesRESUMEN
Following the diagnosis of primary vesicoureteric reflux, identified as part of the investigation of urinary tract infection, 299 refluxing kidneys in 202 children (aged 0-14 years) were prospectively evaluated using intravenous urography (IVU) and the DMSA renal scan at least 4 weeks after urine infection. There was 88% concordance between IVU and the DMSA scan, but in 12% there were discrepancies manifested in 37 kidneys from 31 children. Thirty-four kidneys were normal on IVU but showed scars of reflux nephropathy (RN) on the technetium 99m--dimercaptosuccinic acid (DMSA) renal scan; 4 of these (2 infants and 2 pre-school children) had severe generalized changes on scanning. Three kidneys were normal of DMSA scan and, although abnormal on initial IVU, were considered to be normal when this was repeated. During a follow-up period of 5 years an annual DMSA was undertaken in 194 patients and the renal scars remained unchanged in all except 1 child. The IVU was repeated 1-3 years after the initial study in 31 children in which the results of the first imaging did not agree. In 28 patients (34 kidneys) in which the initial IVU was normal but the DMSA abnormal, IVU evidence of scarring emerged in 30 of 34 kidneys, including the 4 patients with severe generalized damage on the DMSA. We conclude that abnormalities detected by the DMSA scan may precede the radiological findings, especially in young children. Even severe RN can be established in kidneys that appear normal on the IVU.
Asunto(s)
Succímero , Urografía , Reflujo Vesicoureteral/diagnóstico , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Riñón/diagnóstico por imagen , Masculino , Cintigrafía , Reflujo Vesicoureteral/diagnóstico por imagenRESUMEN
In order to investigate aspects of the renal handling of 99mTc-DMSA, 68 isolated rat kidneys were artificially perfused. The experimental groups were: Group 1 (no. = 32)-oxygenated filtering kidneys; Group 2 (no. = 29)-oxygenated non-filtering kidneys; Group 3 (no. = 7)-anaerobic non-filtering kidneys. We conclude that the 99mTc-DMSA complex is strongly bound to albumin, is not filtered and is removed from perfusion fluid through the renal peritubular capillary route and that this occurs by an active process which depends upon aerobic metabolism. This process has a high capacity and is not inhibited by probenecid.