Renal function damage in children with duplex kidneys

Functional assessment of renal damage in children with primary vesicoureteral reflux

Objectives

To evaluate the renal function damage in children with primary vesicoureteral reflux (VUR).

Methods

A total of 226 children with VUR (65 cases with left, 39 with right, and 122 cases with bilateral VUR) were screened. Eighty-five urinary tract infection (UTI) cases, without urinary malformations, during the same period were collected as controls. Age at diagnosis, body weight, renal ultrasound, VUR grade, serum creatinine level, dimercaptosuccinic acid (DMSA) level, and effective renal plasma flow (ERPF) values were retrospectively analyzed.

Results

There were no significant differences in age at diagnosis between study groups. Total ERPF was significantly lower in the bilateral VUR group than in the control group. The ERPF in unilateral VUR was significantly lower than that in the contralateral or ipsilateral side in the control group (P < 0.001). The mean split renal function, as assessed by DMSA of VUR, was 28.00% and 29.12% on the left and right sides, respectively, both of which were lower than the control group's 40.27%. Renal damage was also correlated with a VUR grade (P = 0.008), a transverse diameter (P = 0.002), and pyelectasis (P = 0.037).

Conclusion

Split renal function was impaired in the reflux kidney. The total ERPF in the bilateral VUR group was lower than that in the unilateral VUR group. Renal damage was correlated with a VUR grade, a transverse diameter, and pyelectasis.

Role of Functional SPECT and PET in Renal Emergencies

Renal scintigraphy is a centerpiece of nuclear medicine and is also commonly applied for (peri-)acute care. In this regard, referrals by the treating physician include: I.) acute obstructions caused by gradual and infiltrative tumor growth or renal off-target effects under anti-tumor treatment, II.) functional issues in infants, for example, structural abnormalities such as duplex kidneys or uroliths in adults, which can also trigger III.) Infections of renal parenchyma. Renal radionuclide imaging is also requested due to IV.) acute trauma to the abdomen, for example, to assess renal scarring or upon further follow-up after reconstructive surgery. We will discuss clinical applications of (peri-)acute renal scintigraphy, along with future prospects on the use of more advanced nuclear imaging techniques such as renal positron emission tomography.