RESUMEN
PURPOSE: Ultrasound-guided percutaneous biopsy (USPB) of the native kidneys is the preferred diagnostic method for several nephrological conditions in both adult and pediatric populations. Conventionally, native kidney biopsies are conducted with patients in the prone position (PP). However, an alternative approach involving the supine oblique antero-lateral position (SALP) has been explored, particularly for individuals who are obese, elderly, or critically ill. METHODS: This study aimed to assess the feasibility and outcomes of USPB performed in SALP with a Free-Flank setting (FF-SALP) in pediatric patients (Group A) compared to adults (Group B). Data from kidney biopsies conducted between 2008 and 2021 were gathered. The study focused on the safety and the prevalence of biopsy samples containing a minimum of 10 glomeruli, histopathological yield in both groups. RESULTS: Complication rates were low in both groups (5.6% vs. 3.7%; p = 0.454), without major complications noted. The pediatric group achieved a significantly higher mean number of glomeruli per biopsy compared to the adult group (20.6 ± 12.3 vs. 15.7 ± 9.4; p < 0.001). However, when evaluating the minimum threshold of 10 glomeruli (76.3% vs. 68.5%; p = 0.072) and histopathologic yield (95.3% vs. 93.5%; p = 0.408), no differences were observed between groups. CONCLUSION: USPB of native kidneys in the FF-SALP position is a safe and effective method for tissue sampling in patients with parenchymal disease. It demonstrated comparable diagnostic yields and complication rates in the pediatric and adult populations, providing advantages in terms of airway management, making it particularly useful for pediatric patients that require general anesthesia.
Asunto(s)
Biopsia Guiada por Imagen , Riñón , Posicionamiento del Paciente , Ultrasonografía Intervencional , Humanos , Niño , Masculino , Femenino , Ultrasonografía Intervencional/métodos , Adulto , Biopsia Guiada por Imagen/métodos , Posicionamiento del Paciente/métodos , Riñón/patología , Riñón/diagnóstico por imagen , Adolescente , Posición Supina , Enfermedades Renales/diagnóstico por imagen , Enfermedades Renales/patología , Persona de Mediana Edad , Anciano , Preescolar , Estudios Retrospectivos , Estudios de FactibilidadRESUMEN
Renal abscesses are a rare complication of urinary tract infections and may be associated with increased morbidity and mortality. Most cases occur in patients with predisposing factors such as immunosuppression. Diagnosis requires high clinical suspicion and its treatment consists in the use of parenteral antibiotics and antifungals associated or not with surgical interventions such as nephrostomy and nephrectomy. Few cases have been published in the medical literature of multifocal bilateral renal abscesses and even fewer due to Candida albicans. We present the case of a 20-year-old woman with type 1 diabetes mellitus, diagnosed at age 8, multiple hospitalizations for diabetic ketoacidosis, and recent hospitalization for candidemia (Candida albicans) treated with fluconazole for 23 days. Eighteen days after her discharge, she consulted for dull flank pain and general symptoms. Contrast enhanced abdominal tomography showed bilateral multifocal abscesses and Candida albicans was isolated in one of the samples obtained from lesions. She received fluconazole 400 mg, 6 weeks i.v. and 2 weeks via enteral route, evolving favorably with clinical and imaging improvement, continuing outpatient clinical monitoring. This report highlights the importance of diagnosis and treatment of this rare complication in complex diseases such as diabetes mellitus.
Los abscesos renales son una complicación poco frecuente de las infecciones del tracto urinario y suelen asociarse con un aumento de la morbi-mortalidad. La mayoría de los casos ocurre en pacientes con factores predisponentes como la inmunosupresión. El diagnóstico requiere de una elevada sospecha clínica y el tratamiento consiste en el uso de antibióticos y antifúngicos parenterales asociados o no a intervenciones quirúrgicas como nefrostomía y nefrectomía. Son pocos los casos publicados en la literatura médica de abscesos renales bilaterales multifocales y menos aún por Candida albicans. Se presenta el caso de una mujer de 20 años de edad con diabetes mellitus tipo 1 diagnosticada a los 8 años, múltiples internaciones por cetoacidosis diabética y reciente internación por candidemia (Candida albicans) completando tratamiento con fluconazol por 23 días. A los 18 días de su externación, consulta por dolor en flancos de tipo sordo y síntomas generales; se realizó tomografía de abdomen con contraste que mostró abscesos multifocales bilaterales. Aislándose Candida albicans en una de las muestras obtenidas de las lesiones; recibió tratamiento con fluconazol 400 mg por 6 semanas endovenoso y 2 semanas vía enteral, evolucionando favorablemente con mejoría clínica e imagenológica continuando seguimiento clínico ambulatorio. Este reporte resalta la importancia del diagnóstico y tratamiento de esta complicación infrecuente en enfermedades complejas como la diabetes.
Asunto(s)
Enfermedades Renales , Infecciones Urinarias , Humanos , Femenino , Niño , Adulto Joven , Adulto , Candida albicans , Fluconazol/uso terapéutico , Absceso/diagnóstico por imagen , Absceso/tratamiento farmacológico , Antifúngicos/uso terapéutico , Infecciones Urinarias/tratamiento farmacológico , Enfermedades Renales/diagnóstico por imagen , RiñónRESUMEN
La evaluación de la función renal se realiza habitualmente a través de la estimación de la tasa de filtración glomerular y el análisis de la orina. La evaluación morfológica renal a través de una imagen permite complementar esta información. Sin embargo, muchas de las aplicaciones de las técnicas actuales de imágenes son desconocidas por los médicos clínicos. Además, la comunicación entre médicos clínicos y especialistas en imágenes es menos usual de lo deseable. En esta revisión describiremos los métodos de imagen más frecuentemente utilizados para la evaluación de la función renal y otras situaciones clínicas nefrológicas, además de analizar los avances más significativos, particularmente en ultrasonografía y resonancia magnética, para la pesquisa precoz y seguimiento del daño renal.
The evaluation of kidney function is usually performed through the estimation of the glomerular filtration rate and urine analysis. The evaluation of the kidney morphology through an image complements and enriches this information. However, many of the applications of current imaging techniques are unknown to clinicians. In addition, communication between clinicians and imaging specialists is less common than desirable. In this review, we will describe the imaging methods most frequently used for evaluating kidney function and other clinical situations, in addition to analyzing the most significant advances, particularly in ultrasonography and magnetic resonance imaging, for the early detection and follow-up of kidney damage.
Asunto(s)
Humanos , Tasa de Filtración Glomerular/fisiología , Riñón/fisiología , Riñón/diagnóstico por imagen , Enfermedades Renales/fisiopatología , Enfermedades Renales/diagnóstico por imagen , Imagen por Resonancia Magnética , Ultrasonografía , Pruebas de Función Renal/métodosRESUMEN
The evaluation of kidney function is usually performed through the estimation of the glomerular filtration rate and urine analysis. The evaluation of the kidney morphology through an image complements and enriches this information. However, many of the applications of current imaging techniques are unknown to clinicians. In addition, communication between clinicians and imaging specialists is less common than desirable. In this review, we will describe the imaging methods most frequently used for evaluating kidney function and other clinical situations, in addition to analyzing the most significant advances, particularly in ultrasonography and magnetic resonance imaging, for the early detection and follow-up of kidney damage.
Asunto(s)
Tasa de Filtración Glomerular , Enfermedades Renales , Riñón , Imagen por Resonancia Magnética , Humanos , Riñón/diagnóstico por imagen , Riñón/fisiología , Tasa de Filtración Glomerular/fisiología , Enfermedades Renales/diagnóstico por imagen , Enfermedades Renales/fisiopatología , Pruebas de Función Renal/métodos , Ultrasonografía/métodosRESUMEN
ABSTRACT Objective To evaluate usage of renal artery embolization (RAE) for renal injuries and discuss the indications for this treatment. Materials and Methods A retrospective study was performed evaluating the electronic medical records of all patients with renal trauma admitted to two major comprehensive hospitals in Shantou city from January 2006 to December 2015. Results There were 264 and 304 renal traumatic patients admitted to hospital A and B, respectively. LGRT was the reason for presentation in the majority of patients (522, 91.9%). A total of 534 (94.0%) patients were treated conservatively. RAE was performed in 9 patients from 2012 to 2015 at hospital A, including in 6 patients (6/9, 66.7%) with LGRT, and 3 patients (3/9, 33.3%) with HGRT. No patient underwent interventional therapy (RAE) at hospital B during the same period. No significant differences in the operative rate of hospital A were observed between the two time periods (2006-2011 and 2012-2015). The operative rate for LGRT between the two hospitals from 2006 to 2011 and 2012 to 2015 was not significantly different. Hospital A showed a significant decrease in the rate of conservative treatment for patients with LGRT. In the univariate and multivariate analyses, the AAST renal grade both were significantly associated with undergoing RAE. Conclusions LGRT was present in the majority of patients, and most cases of renal trauma could be treated with conservative treatment. RAE was well utilized for the treatment of renal trauma. However, some patients with LGRT were treated with unnecessary interventional therapy.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Anciano , Adulto Joven , Arteria Renal/lesiones , Embolización Terapéutica/métodos , Riñón/irrigación sanguínea , Enfermedades Renales/terapia , Índices de Gravedad del Trauma , Estudios Retrospectivos , Resultado del Tratamiento , Enfermedades Renales/etiología , Enfermedades Renales/diagnóstico por imagen , Persona de Mediana EdadAsunto(s)
Humanos , Masculino , Persona de Mediana Edad , Cadenas kappa de Inmunoglobulina/análisis , Podocitos/inmunología , Enfermedades Renales/inmunología , Túbulos Renales Proximales/inmunología , Paraproteinemias/complicaciones , Dexametasona/uso terapéutico , Resultado del Tratamiento , Creatinina/sangre , Cristalización , Ciclofosfamida/uso terapéutico , Microscopía Electrónica de Transmisión/métodos , Diagnóstico Diferencial , Albuminuria/etiología , Quimioterapia Combinada , Podocitos/patología , Podocitos/ultraestructura , Lesión Renal Aguda/diagnóstico , Bortezomib/uso terapéutico , Enfermedades Renales/diagnóstico por imagen , Túbulos Renales Proximales/ultraestructura , Antiinflamatorios/uso terapéutico , Antineoplásicos/uso terapéuticoRESUMEN
OBJECTIVE: To evaluate usage of renal artery embolization (RAE) for renal injuries and discuss the indications for this treatment. MATERIALS AND METHODS: A retrospective study was performed evaluating the electronic medical records of all patients with renal trauma admitted to two major comprehensive hospitals in Shantou city from January 2006 to December 2015. RESULTS: There were 264 and 304 renal traumatic patients admitted to hospital A and B, respectively. LGRT was the reason for presentation in the majority of patients (522, 91.9%). A total of 534 (94.0%) patients were treated conservatively. RAE was performed in 9 patients from 2012 to 2015 at hospital A, including in 6 patients (6/9, 66.7%) with LGRT, and 3 patients (3/9, 33.3%) with HGRT. No patient underwent interventional therapy (RAE) at hospital B during the same period. No significant differences in the operative rate of hospital A were observed between the two time periods (2006-2011 and 2012-2015). The operative rate for LGRT between the two hospitals from 2006 to 2011 and 2012 to 2015 was not significantly different. Hospital A showed a significant decrease in the rate of conservative treatment for patients with LGRT. In the univariate and multivariate analyses, the AAST renal grade both were significantly associated with undergoing RAE. CONCLUSIONS: LGRT was present in the majority of patients, and most cases of renal trauma could be treated with conservative treatment. RAE was well utilized for the treatment of renal trauma. However, some patients with LGRT were treated with unnecessary interventional therapy.
Asunto(s)
Embolización Terapéutica/métodos , Enfermedades Renales/terapia , Riñón/irrigación sanguínea , Arteria Renal/lesiones , Adolescente , Adulto , Anciano , Femenino , Humanos , Enfermedades Renales/diagnóstico por imagen , Enfermedades Renales/etiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Índices de Gravedad del Trauma , Resultado del Tratamiento , Adulto JovenAsunto(s)
Cadenas kappa de Inmunoglobulina/análisis , Enfermedades Renales/inmunología , Túbulos Renales Proximales/inmunología , Podocitos/inmunología , Lesión Renal Aguda/diagnóstico , Albuminuria/etiología , Antiinflamatorios/uso terapéutico , Antineoplásicos/uso terapéutico , Bortezomib/uso terapéutico , Creatinina/sangre , Cristalización , Ciclofosfamida/uso terapéutico , Dexametasona/uso terapéutico , Diagnóstico Diferencial , Quimioterapia Combinada , Humanos , Hipopotasemia/etiología , Inmunosupresores/uso terapéutico , Enfermedades Renales/diagnóstico por imagen , Enfermedades Renales/patología , Túbulos Renales Proximales/patología , Túbulos Renales Proximales/ultraestructura , Masculino , Microscopía Electrónica de Transmisión/métodos , Persona de Mediana Edad , Paraproteinemias/complicaciones , Podocitos/patología , Podocitos/ultraestructura , Resultado del TratamientoRESUMEN
Renal artery thrombosis is a rare clinical condition. Often, there is a delay in diagnosis due to non-specific clinical complaints. We presented a woman with an elderly atrial fibrillation who developed thrombosis of the left renal artery. Despite the anticoagulant treatment given, patient did not benefit and the kidney was fully damaged.
Asunto(s)
Fibrilación Atrial/complicaciones , Enfermedades Renales/diagnóstico por imagen , Arteria Renal/diagnóstico por imagen , Trombosis/diagnóstico por imagen , Anciano , Femenino , Humanos , Enfermedades Renales/complicaciones , Arteria Renal/patología , Trombosis/complicaciones , Tomografía Computarizada por Rayos XRESUMEN
The use of echocardiography is very useful in the evaluation, treatment, and follow-up of the patient in critical condition. Along with clinic and the stethoscope, it is a tool that complements the act of the physician faced with the diversity of etiologies that determine the state of shock and increase morbidity and mortality, especially in post-cardiac surgery patients, in whom there are no management emergency post-surgical algorithms. In view of this situation, at the National Institute of Cardiology Ignacio Chávez, a management algorithm has been made and improved in cardiac post-surgical patients: through focused ultrasonography, including transthoracic echography, pulmonary ultrasound, optic nerve ultrasound, and renal ultrasound by evaluating renal resistive indices. Several societies have created their protocols for addressing patients in critical condition, so in the institute, specifically in cardiovascular intensive therapy, has created the cardiac, cerebral, renal, optic nerve, and lung ultrasound study (CCROSS) protocol for the initial approach of these patients, and a study is currently taking place for its validation, reproducibility, and efficacy.
El uso de ecocardiografía enfocada es de gran utilidad en la valoración, tratamiento y seguimiento del paciente en estado crítico. Es, junto con la clínica y el estetoscopio, una herramienta que complementa el actuar del médico ante las diversas etiologías que determinan un estado de choque o aumentan la morbimortalidad, especialmente en pacientes posquirúrgicos de cirugía cardíaca, en quienes no se tiene algoritmos de manejo emergente en el posquirúrgico. Ante tal situación, en el Instituto Nacional de Cardiología Ignacio Chávez se ha realizado y propuesto un algoritmo de manejo en los pacientes posquirúrgicos cardíacos: mediante ultrasonografía enfocada, abarcando ecoscopia transtorácica, ultrasonido pulmonar, ultrasonido del nervio óptico y renal mediante la valoración de índices resistivos renales. Diversas sociedades han creado sus protocolos de abordaje en pacientes en estado crítico, por lo que en el Instituto, específicamente en la terapia intensiva cardiovascular, ha creado el protocolo CCROSS (Cardiac, Cerebral, Renal, Optic nerve, lung ultraSound Study) para el abordaje inicial de estos pacientes y se encuentra en marcha actualmente un estudio para su validación, reproducibilidad y eficacia.
Asunto(s)
Algoritmos , Procedimientos Quirúrgicos Cardíacos , Protocolos Clínicos , Cardiopatías/diagnóstico por imagen , Enfermedades Renales/diagnóstico por imagen , Enfermedades Pulmonares/diagnóstico por imagen , Enfermedades del Sistema Nervioso/diagnóstico por imagen , Cuidados Posoperatorios/métodos , Complicaciones Posoperatorias/diagnóstico por imagen , Ultrasonografía , Encéfalo/diagnóstico por imagen , Ecocardiografía , Humanos , Nervio Óptico/diagnóstico por imagenRESUMEN
Resumen El uso de ecocardiografía enfocada es de gran utilidad en la valoración, tratamiento y seguimiento del paciente en estado crítico. Es, junto con la clínica y el estetoscopio, una herramienta que complementa el actuar del médico ante las diversas etiologías que determinan un estado de choque o aumentan la morbimortalidad, especialmente en pacientes posquirúrgicos de cirugía cardíaca, en quienes no se tiene algoritmos de manejo emergente en el posquirúrgico. Ante tal situación, en el Instituto Nacional de Cardiología Ignacio Chávez se ha realizado y propuesto un algoritmo de manejo en los pacientes posquirúrgicos cardíacos: mediante ultrasonografía enfocada, abarcando ecoscopia transtorácica, ultrasonido pulmonar, ultrasonido del nervio óptico y renal mediante la valoración de índices resistivos renales. Diversas sociedades han creado sus protocolos de abordaje en pacientes en estado crítico, por lo que en el Instituto, específicamente en la terapia intensiva cardiovascular, ha creado el protocolo CCROSS (Cardiac, Cerebral, Renal, Optic nerve, lung ultraSound Study) para el abordaje inicial de estos pacientes y se encuentra en marcha actualmente un estudio para su validación, reproducibilidad y eficacia.
Abstract The use of echocardiography is very useful in the evaluation, treatment and follow-up of the patient in critical condition. Along with clinic and the stethoscope, it is a tool that complements the act of the physician faced with the diversity of etiologies that determine the state of shock and increase morbidity and mortality, especially in post cardiac surgery patients, in whom there are no management emergency postsurgical algorithms. In view of this situation, at the National Institute of Cardiology Ignacio Chávez, a management algorithm has been made and improved in cardiac postsurgical patients: through focused ultrasonography, including transthoracic echography, pulmonary ultrasound, optic nerve ultrasound, and renal ultrasound by evaluating renal resistive indices. Several societies have created their protocols for addressing patients in critical condition, so in the Institute, specifically in cardiovascular intensive therapy, has created the CCROSS protocol (Cardiac, Cerebral, Renal, Optic nerve, lung UltraSound Study) for the initial approach of these patients, and it is being carried out a study for its validation, reproducibility and efficacy.
Asunto(s)
Humanos , Cuidados Posoperatorios/métodos , Complicaciones Posoperatorias/diagnóstico por imagen , Algoritmos , Protocolos Clínicos , Ultrasonografía , Cardiopatías/diagnóstico por imagen , Procedimientos Quirúrgicos Cardíacos , Enfermedades Renales/diagnóstico por imagen , Enfermedades Pulmonares/diagnóstico por imagen , Enfermedades del Sistema Nervioso/diagnóstico por imagen , Nervio Óptico/diagnóstico por imagen , Encéfalo/diagnóstico por imagen , EcocardiografíaRESUMEN
PURPOSE: To describe the morphology and function of duplicated collecting systems in pediatric patients undergoing functional MR urography (fMRU). METHODS: This is a HIPAA compliant IRB approved retrospective study of all patients with duplicated renal collecting systems undergoing fMRU at our institution between 2010 and 2017. Two pediatric radiologists evaluated the studies to determine the presence, morphology and function of duplicated collecting systems using both T2-weighted and dynamic post-contrast fat saturated T1-weighted images. Assessed morphologic features included pelvic and calyceal dilation, partial or complete ureteral duplication, ureteral dilation, ectopic ureteral insertion and ureteroceles. Functional analysis was carried out per moiety. RESULTS: A total of 86 examinations (63 girls; 23 boys), median age 2.6â¯years (Standard Deviation 6.4â¯years, interquartile range: 0.4-10.3â¯years) and 107 kidneys (39 right; 30 left and 19 bilateral), which yielded 214 evaluable moieties, were included in the final sample. One hundred and sixty-three (76.1%) of the moieties had normal morphological features and normal functional results (average calyceal transit time and renal transit time of 2â¯min 28â¯s and 3â¯min 16â¯s, respectively). The remaining 51 moieties (23.8%) were hypoplastic or dysplastic. Seventy-seven (35.9%) had pelvic and calyceal dilation. Slightly more than half of the kidneys had complete ureteral duplication (60/107; 56%); 50 (50/107, 46.7%) had ectopic ureters (23 intra- and 27 extravesical) and 9 (9/107, 8.4%) had ureteroceles. CONCLUSION: fMRU provides comprehensive information regarding the morphology and function of duplicated renal collecting systems in children. In particular, fMRU is useful for assessing barely or non-functioning renal poles and ectopic ureters.
Asunto(s)
Enfermedades Renales/diagnóstico por imagen , Riñón/anomalías , Imagen por Resonancia Magnética/métodos , Urografía/métodos , Insuficiencia Suprarrenal , Niño , Preescolar , Femenino , Retardo del Crecimiento Fetal , Humanos , Lactante , Enfermedades Renales/fisiopatología , Masculino , Osteocondrodisplasias , Estudios Retrospectivos , Uréter/diagnóstico por imagen , Obstrucción Ureteral/diagnóstico por imagen , Obstrucción Ureteral/fisiopatología , Anomalías UrogenitalesRESUMEN
The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.
Asunto(s)
Biopsia/métodos , Enfermedades Renales/patología , Riñón/patología , Laparoscopía/métodos , Femenino , Humanos , Enfermedades Renales/diagnóstico por imagen , Masculino , Guías de Práctica Clínica como Asunto , Espacio Retroperitoneal , Tomografía Computarizada de EmisiónRESUMEN
The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.
Asunto(s)
Humanos , Masculino , Femenino , Biopsia/métodos , Laparoscopía/métodos , Riñón/patología , Enfermedades Renales/patología , Espacio Retroperitoneal , Tomografía Computarizada de Emisión , Guías de Práctica Clínica como Asunto , Enfermedades Renales/diagnóstico por imagenRESUMEN
ABSTRACT Purpose: To identify the fetal stem cell (FSC) response to maternal renal injury with emphasis on renal integrity improvement and Y chromosome detection in damaged maternal kidney. Materials and Methods: Eight non-green fluorescent protein (GFP) transgenic Sprague-Dawley rats were mated with GFP-positive transgenic male rats. Renal damage was induced on the right kidney at gestational day 11. The same procedure was performed in eight non-pregnant rats as control group. Three months after delivery, right ne- phrectomy was performed in order to evaluate the injured kidney. The fresh perfused kidneys were stained with anti-GFP antibody. Polymerase chain reaction (PCR) assay was also performed for the Y chromosome detection. Cell culture was performed to detect the GFP-positive cells. Technetium-99m-DMSA renal scan and single-photon emission computed tomography (SPECT) were performed after renal damage induction and 3 months later to evaluate the improvement of renal integrity. Results: The presence of FSCs was confirmed by immune histochemical staining as well as immunofluorescent imaging of the damaged part. Gradient PCR of female rat purified DNA demonstrated the presence of Y-chromosome in the damaged maternal kidney. Moreover, the culture of kidney cells showed GPF- positive cells by immuno- fluorescence microscopy. The acute renal scar was repaired and the integrity of dam- aged kidney reached to near normal levels in experimental group as shown in DMSA scan. However, no significant improvement was observed in control group. Conclusion: FSC seems to be the main mechanism in repairing of the maternal renal injury during pregnancy as indicated by Y chromosome and GFP-positive cells in the sub-cultured medium.
Asunto(s)
Animales , Masculino , Femenino , Embarazo , Cicatrización de Heridas/fisiología , Quimerismo , Células Madre Fetales/fisiología , Enfermedades Renales/fisiopatología , Intercambio Materno-Fetal/fisiología , Factores de Tiempo , Cromosoma Y , Inmunohistoquímica , Tomografía Computarizada de Emisión de Fotón Único , Células Cultivadas , Reacción en Cadena de la Polimerasa , Técnica del Anticuerpo Fluorescente , Ratas Sprague-Dawley , Radiofármacos , Ácido Dimercaptosuccínico de Tecnecio Tc 99m , Modelos Animales de Enfermedad , Enfermedades Renales/patología , Enfermedades Renales/diagnóstico por imagenRESUMEN
ABSTRACT Renal replacement lipomatosis is a condition characterized by varying degrees of renal parenchymal atrophy and perirenal fibrofatty proliferation secondary to chronic inflammation such as xanthogranulomatous pyelonephritis. In severe cases, imaging findings can be misdiagnosed as retroperitoneal liposarcoma.
Asunto(s)
Humanos , Masculino , Neoplasias Retroperitoneales/diagnóstico por imagen , Pielonefritis Xantogranulomatosa/diagnóstico , Enfermedades Renales/diagnóstico por imagen , Lipomatosis/diagnóstico por imagen , Liposarcoma/diagnóstico por imagen , Neoplasias Retroperitoneales/patología , Pielonefritis Xantogranulomatosa/patología , Radiografía Abdominal , Tomografía Computarizada por Rayos X , Diagnóstico Diferencial , Enfermedades Renales/patología , Lipomatosis/patología , Liposarcoma/patología , Persona de Mediana EdadRESUMEN
Renal replacement lipomatosis is a condition characterized by varying degrees of renal parenchymal atrophy and perirenal fibrofatty proliferation secondary to chronic inflammation such as xanthogranulomatous pyelonephritis. In severe cases, imaging findings can be misdiagnosed as retroperitoneal liposarcoma.
Asunto(s)
Enfermedades Renales/diagnóstico por imagen , Lipomatosis/diagnóstico por imagen , Liposarcoma/diagnóstico por imagen , Pielonefritis Xantogranulomatosa/diagnóstico por imagen , Neoplasias Retroperitoneales/diagnóstico por imagen , Diagnóstico Diferencial , Humanos , Enfermedades Renales/patología , Lipomatosis/patología , Liposarcoma/patología , Masculino , Persona de Mediana Edad , Pielonefritis Xantogranulomatosa/patología , Radiografía Abdominal , Neoplasias Retroperitoneales/patología , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: The purpose of this study was to determine whether unenhanced MRI without sedation is a feasible substitute for dimercaptosuccinic acid (DMSA) scintigraphy in the detection of renal scars in pediatric patients. SUBJECTS AND METHODS: Patients scheduled for 99mTc-labeled DMSA scintigraphy for assessment of possible renal scars were recruited to undergo unenhanced MRI (free-breathing fat-suppressed T2-weighted single-shot turbo spin-echo and T1-weighted gradient-echo imaging, 13 minutes' total imaging time). Scintigraphic and MRI studies were evaluated by two independent blinded specialty-based radiologists. For each imaging examination, readers identified scars in upper, middle, and lower kidney zones and rated their diagnostic confidence and the quality of each study. The scintigraphic readers' consensus score opinion for the presence of scars was considered the reference standard. RESULTS: DMSA scintigraphy showed scarring in 19 of the 78 (24.4%) evaluated zones and MRI in 18 of the 78 (23.1%). The two MRI readers found mean sensitivities of 94.7% and 89.5%, identical specificities of 100%, and diagnostic accuracies of 98.7% and 97.4%. Interobserver agreement was 98.7% for MRI and 92.3% for DMSA scintigraphy. The MRI readers were significantly more confident in determining the absence rather than the presence of scars (p = 0.02). MRI readers were more likely to rate study quality as excellent (84.6%) than were the scintigraphic readers (57.7%) (p = 0.024). CONCLUSION: Unenhanced MRI has excellent sensitivity, specificity, diagnostic accuracy, and interobserver agreement for detecting renal scars in older children who do not need sedation. It may serve as a substitute modality, especially when DMSA is not available.