• Childhood Kidney Diseases
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• v.26 no.1
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• pp.52-57
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• 2022

Purpose: To determine predictive factors for detecting renal parenchymal damages (RPDs) in infants with recurrent febrile urinary tract infection (fUTI). Methods: From January 2015 to December 2021, 102 infants with recurrent fUTI and who underwent ^99mTc-dimercaptosuccinic acid (DMSA) renal scan in our hospital were included in this study. Controls included infants with normal DMSA results performed 3 months apart from the 2nd episode of fUTI. DMSA-positive group included infants with positive DMSA results performed 3 months apart from the 2nd episode of fUTI or at the 3rd episode of fUTI. The recurrence rate, causative bacteria, renal size discrepancy of both kidneys, and laboratory findings including C-reactive protein (CRP) and spot urine sodium-to-potassium ratio (uNa/K) were compared between both groups. Results: Only 3.8% of 79 infants with a 2nd episode of fUTI showed positive DMSA results. fUTI recurred more frequently within 12 months of follow-up in the DMSA-positive group than in the control group (69% vs. 13%, P<0.001). CRP values were significantly higher in the DMSA-positive group than in the control group (7.3 mg/dL vs. 3.7 mg/dL, P<0.001). Spot uNa/K were significantly lower in the DMSA-positive group than in the control group (0.6 vs. 1.1, P<0.001). Conclusions: Congenital renal scar and RPDs on the DMSA scan were more frequently found in infants with recurrent fUTI than those in the control group. High CRP values and low spot uNa/K in acute infections were helpful in predicting the presence of RPD in infants with recurrent fUTI.

• Childhood Kidney Diseases
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• v.20 no.2
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• pp.57-62
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• 2016

Purpose: We used technetium-99m dimercaptosuccinic acid (DMSA) scintigraphy to identify factors predictive of renal cortical defects in infants <3 months of age with urinary tract infections (UTIs). Methods: We retrospectively reviewed data on infants <3 months of age with culture-proven UTIs treated at a single center from March 2010 to February 2016. Blood samples were obtained for laboratory evaluation prior to commencement of antibiotic therapy. The therapeutic delay time (TDT) and therapeutic response time (TRT) were recorded. All patients were divided into two groups depending on features of their DMSA scans. We compared the demographic, clinical, and laboratory characteristics of the two groups. Results: A total of 119 infants (94 males and 25 females; mean age, $56.9{\pm}21.3days$) were included. Cortical defects were evident in the DMSA scans of 47 cases (39.5%). In infants with such defects, the peak temperatures ($38.9{\pm}0.57^{\circ}C$ vs. $38.4{\pm}0.81^{\circ}C$, P=0.001), the absolute neutrophil counts ($8,920{\pm}4,460/mm$ vs. $7,290{\pm}4,090/mm$, P=0.043), and the C-reactive protein (CRP) levels ($6.49{\pm}4.33mg/dL$ vs. $3.21{\pm}2.81mg/dL$, P=0.001) were significantly higher than those in infants without cortical defects. The TDT was also longer in those with cortical defects (P=0.037). Conclusion: We found that a TDT ${\geq}8.5hr$ (odds ratio [OR] 5.81), a peak temperature ${\geq}38.3^{\circ}C$ (OR 6.19), and a CRP level ${\geq}4.96mg/dL$ (OR 7.26) predicted abnormal DMSA scan results in infants <3 months of age with UTIs.

• The Korean Journal of Nuclear Medicine Technology
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• v.14 no.1
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• pp.73-77
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• 2010

Purpose: The nuclear medicine technology has been changed. The hard ware is developed so much. Also the soft ware performs a meritorious deed for the development of nuclear medicine technology. We could use the automated region of interest (ROI) instead of manual ROI. We want to know that what difference of quantitative analysis is there between automated ROI and manual ROI Materials and Methods: There are three experimental to make results. The first is what comparing the renal automated ROI and manual ROI. The second is that we compared three threshold ROI that size is difference each others with visible decision. The third is that we compared full, half, quarter automated background, and survey relative function. Results: Although the first has statistically not significant difference, the second and third have significant difference. Threshold, setting smaller threshold then renal outline or bigger, has statistically significant difference (p<0.01). The third is performed with the first experimental. Full background has significant difference, comparing each three type background (p<0.05). Conclusion: The results that there is not significant difference between automated ROI and manual ROI will increase objectivity and operator's convenience. We could know that smaller threshold then renal out line has significant difference in the second experimental. And the third experimental has results because of a increased background nearby live and spleen.

• Childhood Kidney Diseases
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• v.20 no.2
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• pp.63-68
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• 2016

Purpose: Disruption of normal renal development can lead to congenital anomalies of the kidney and urinary tract, including renal hypodysplasia. We aimed to clarify whether small kidney size affects clinical manifestations in children with urinary tract infection (UTI). Methods: One hundred fifty-four patients who had their first symptomatic UTI between January 2014 and June 2015 were enrolled in this study. Differences in kidney size were estimated based on percent uptake of $^{99m}Tc-$ dimercaptosuccinic acid (DMSA) in scintigraphy. The patients who showed more than 10% difference in kidney size on DMSA scintigraphy with none or minimal cortical defects were included in group A. (group A, n=17). Laboratory, clinical, and imaging results were compared with those of the other patients (group B, n=137). Results: Group A had a relatively higher incidence of vesicoureteral reflux than group B (44% vs 20%, P<0.05). The levels of plasma neutrophil gelatinase-associated lipocalin (NGAL) and serum C-reactive protein were significantly higher in group A (193 [64-337] vs 91 [59-211] ng/mL and 4.1 [0.5-11.9] vs 2.1 [0.7-5.3] ng/mL, respectively; all P <0.05). Linear regression analysis revealed that plasma NGAL level strongly correlated with the difference in renal uptake in DMSA scintigraphy in group A ($R^2=0.505$). Conclusion: The difference in kidney size could influence the clinical course and severity of pediatric UTI.

• The Korean Journal of Nuclear Medicine Technology
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• v.20 no.2
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• pp.27-31
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• 2016

Purpose $^{99m}Tc-DMSA$ renal scan is a test for the comparison of the function by imaging the parenchyma of the kidneys by the cortex of a kidney and by computing the intake ratio of radiation by the left and right kidney. Since the distance between the kidneys and the bladder is not far given the bodily structure of an infant, the bladder is included in the examination domain. Research was carried out with the presumption that counts of bladder would impart an influence on the kidneys at the time of this renal scan. In consideration of the special feature that only a trace amount of a RI is injected in a pediatric examination, research on the method of injection was also carried out concurrently. Materials and Methods With 34 infants aged between 1 month to 12 months for whom a $^{99m}Tc-DMSA$ renal scan was implemented on the subjects, a Post IMAGE was acquired in accordance with the test time after having injected the same quantity of DMSA of 0.5mCi. Then, after having acquired an additional image by shielding the bladder by using a circular lead plate for comparison purposes, a comparison was made by illustrating the percentile of (Lt. Kidney counts + Rt. Kidney counts)/ Total counts, by drawing the same sized ROI (length of 55.2mm X width of 70.0mm). In addition, in the format of a 3-way stopcock, a Heparin cap and direct injection into the patient were performed in accordance with RI injection methods. The differences in the count changes in accordance with each of the methods were compared by injecting an additional 2cc of saline into the 3-way stopcock and Heparin cap. Results The image prior to shielding of the bladder displayed a kidney intake rate with a deviation of $70.9{\pm}3.18%$ while the image after the shielding of the bladder displayed a kidney intake rate with a deviation of $79.4{\pm}5.19%$, thereby showing approximately 6.5~8.5% of difference. In terms of the injection method, the method that used the 3-way form, a deviation of $68.9{\pm}2.80%$ prior to the shielding and a deviation of $78.1{\pm}5.14%$ after the shielding were displayed. In the method of using a Heparin cap, a deviation of $71.3{\pm}5.14%$ prior to the shielding and a deviation of $79.8{\pm}3.26%$ after the shielding were displayed. Lastly, in the method of direct injection into the patient, a deviation of $75.1{\pm}4.30%$ prior to the shielding and a deviation of $82.1{\pm}2.35%$ after the shielding were displayed, thereby illustrating differences in the kidney intake rates in the order of direct injection, a Heparin cap and the 3-way methods. Conclusion Since a substantially minute quantity of radiopharmaceuticals is injected for infants in comparison to adults, the cases of having shielded the bladder by removing radiation of the bladder displayed kidney intake rates that are improved from those of the cases of not having shielded the bladder. Although there are difficulties in securing blood vessels, it is deemed that the method of direct injection would be more helpful in acquisition of better images since it displays improved kidney intake rate in comparison to other methods.

• Childhood Kidney Diseases
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• v.8 no.2
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• pp.239-243
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• 2004

Acute poststreptococcal glomerulonephritis(APSGN) is the most common form of postinfectious glomerulonephritis, and acute pyelonephritis(APN) is the most severe form of urinary tract infection in childhood. However, the concurrence of two diseases is uncommon in the literature. We describe a case of APSGN accompanied with APN in a 5-year-old female who presented with fever, left flank pain, headache and facial edema. Urinalysis showed pyuria, microscopic hematuria, and mild proteinulra. Serial urine cultures grew Escherichia coli. ${^99m}$Tc-DMSA renal scan revealed a cortical defect in the upper pole of left kidney. She had a history of preceding pharyngitis, in addition, showed high blood pressure, high anti-streptolysin 0 titer, and low serum complement levels. The patient improved completely with supportive treatment, Including antibiotic and antihypertensive therapy. These findings suggested that APSGN and APN could be manifested simultaneously or be .superimposed on each other.

• The Korean Journal of Nuclear Medicine
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• v.26 no.2
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• pp.327-332
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• 1992

$^{99m}Tc-dimercaptosuccinic$ acid (DMSA) 주사후 일정시간에 측정한 절대적 신섭취량은 기능이 살아있는 신피질량과 관계있다. 소아의 신기능은 출생후 계속 성숙되어 생후 약 $1\sim2$년에 성인의 기능에 도달하는데 DMSA섭취도 성인과는 다른 양상을 보일 것으로 기대되며 신질환에서 절대적 신섭취율의 평가는 연령을 고려해야 할 것이다. 저자들은 DMSA 스캔을 시행한 소아 환자를 대상으로 스캔상 피질 결손이 없으며 양측신의 섭취율이 비슷하고 혈중 크레아티닌치가 정상인 경우를 대조군으로 하여 연령별 DMSA의 절대적 신섭취율을 구하였고 방광요관역류를 가진 환아를 대상으로 DMSA스캔을 시행하고 신섭취율을 조사하였다. 1) 대조군은 모두 65명으로 좌우측 신섭취율의 유의한 차이는 없었으며 연령에 따라 2세경에 플라토에 도달하였는데 한쪽 신장의 평균섭취율은 3개월 미만이 $14.5{\pm}3.1%$ ID, 3개월에서 6개월 미만이 $17.2{\pm}2.1%$ID, 6개월에서 1년 미만이 $18.4{\pm}1.3%$ID, 1년에서 1년6개월 미만이 $19.3{\pm}1.1%$ID, 1년 6개월에서 2년 미만이 $21.9{\pm}2.0%$ID, 2세이상 15세이하가 $20.1{\pm}0.6%$ID였으며 전체 평균섭취율은 $19.4{\pm}0.5%$ID (injected dose, $mean{\pm}S.E.$)였다. 2) 방광요관역류를 가진 환아는 55명 (일측성 56명, 양측성 29명)으로 109신장을 대상으로 하였다. 방광요관역류의 정도와 피질결손의 수와는 대체로 비례관계가 있었으나 방광요관역류가 없으면서 피질결손이 있는 경우가 25신장중 2예 (8%)였으며, 방광요관역류가 있는 84신장중 27예 (32.1%), 이중에서 방광요관역류가 3도 이상인 62신장중 13예 (21%)에서는 피질결손이 없었다. 3) 이환신의 DMSA 섭취율을 연령에 따른 대조군의 섭취율에 대한 비(섭취율비)로 나타내면 한쪽에 역류가 있을 때 이환신의 경우 $0.55{\pm}0.06$, 정상신의 경우 $1.34{\pm}0.05$이었으며, 양쪽에 역류가 있을 때는 평균 $0.82{\pm}0.08$ $(mean{\pm}S.E.)$ 이었다. 4) 피질결손이 있는 신장의 절대 DMSA 신섭취율은 감소되어 있었고 상대측 신장의 섭취율은 피질 결손이 있더라도 대상적인 증가의 경향을 보였다. 이상의 결과로 소아에서 DMSA 절대적 신섭취율의 연령에 따른 변화를 알 수 있었으며 방광요관역류의 정도와 피질결손의 정도가 반드시 비례하지만은 않아서 시간경과에 따른 추후 검사가 필요하리라 생각된다. 또한 방광요관역류가 있는 환아에서 DMSA 섭취율로 신기능을 평가할 때, 특히 영유아에서 연령에 따른 고려가 있어야 할 것으로 보인다.

• Childhood Kidney Diseases
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• v.1 no.1
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• pp.31-37
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• 1997

The DMSA scan is a useful radiologic study in diagnosis of morphologic and functional diseases of kidney. We evaluated the distribution of sex and age, clinical manifestations, diagnosis, combined diseases, treatment and prognosis of the 61 patients with non-functioning kidney(no isotope uptake or uptake below 5% in DMSA scan) who admitted in our hospital from 1980 to 1995. The proportion of patients under 1 year old age was 46%. Sex ratio was 1.4:1 with male predominance. Most diagnosis of non-functioning kidneys were congenital such as multicystic dysplastic kidney, hydronephrosis due to ureteropelvic junction obstruction, renal agenesis and renal hypoplasia. In order of frequency thirty one percent of them were previously detected on antenatal ultrasonogram. Treatment consisted of operation in 47.5%, mostly nephrectomy and 32.8% of patients were followed up at OPD base without definite treatment. The most common combined diseases was hydronephrosis, in 4patients who had both kidneys inveloved progressed to chronic renal failure, but the prognosis in most cases were good. It is important to evaluate renal diseases in perinatal periods, and we believe that highly sensitive diagnostic study contribute to early treatment plan and thus to good prognosis.

• Childhood Kidney Diseases
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• v.18 no.1
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• pp.29-35
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• 2014

Introduction: Persistent vesicoureteral reflux (VUR), a major cause of urinary tract infection (UTI) in children, can result in serious renal complications, such as reflux nephropathy and chronic renal failure. We evaluated the clinical characteristics and prognostic factors of VUR. Methods: From December 1993 to May 2011, we examined 117 children with vesicoureteral reflux who were admitted to the Department of Pediatrics and Urology, Chungbuk National University hospital for a UTI. The patients were managed medically or surgically. Results: Male patients had a slightly higher prevalence of VUR than female patients (55%). The degrees of the 161 refluxing ureters, as classified by the International Reflux Study Committee, were as follows: grade I, 15 ureters; grade II, 32 ureters; grade III, 54 ureters; grade IV, 26 ureters; grade V, 34 ureters. One hundred and sixty-one renal units (115 cases) underwent a 99m TC-DMSA renal scan, and 62% showed abnormal findings. The incidence of renal cortical defects showed a direct correlation with the severity of VUR. Ninety-four refluxing ureters were followed up medically, and 66 ureters (67%) either disappeared or improved. However, 9 refluxing ureters persisted. The spontaneous resolution rate of VUR seemed to be higher in younger patients with lower grades of reflux, and without renal cortical defects. Sixty-seven refluxing ureters (41%) were treated surgically, 62 refluxing ureters (92%) disappeared, and 5 refluxing ureters (8%) persisted. Conclusion: The incidence of renal cortical defects in patients with UTIs was 62% (in a 99m TC-DMSA renal scan), and showed a direct correlation with the severity of VUR. The spontaneous resolution rate seemed to be lower in the patients with higher grades of VUR, older age (over 4 years old) and diffuse renal cortical defects.

• Childhood Kidney Diseases
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• v.3 no.2
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• pp.117-122
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• 1999

Purpose : We studied the correlation between urinalysis and radiologic findings in infants and children with urinary tract infection. Method : Urine Dipstick test and unstained urine microscopic examination were carried out in 56 infants and children who were hospitallized with the diagnosis of urinary infection by pocitive urine culture at Seoul Adventist from September 1996 through August 1998. Urine was collected by midsream, catheter, urine bag after cleansing or bladder puncture. Renal sonography and $^{99m}Tc-DMSA$ renal scan or voiding cystoureterography were studied. Results : 1)In dipstick analysis, leukocyte esterase(LE) were positive in 30 cases of 56 patients(54%) and Nitrite were positive in 20 cases of 56 patients(36%) and LE or Nitrite were positive in 38 cases of 56 children with UTI(68%). 2)In microscopic analysis, WBC were positive in 38 cases of patients(68%) and bacteria were positive in 23 cases of 56 patients(41%) and WBC or bacteria were positive in 41 cases of 56 children with UTI(71%). 3)Ten cases of 56 UTI patients(18%) showed negative finding in Dipstick and microscopic analysis. 4)There was no significant difference in positive rate of dipstick(71% vs 66%) and microscopia analysis(83% vs 66%) between two group with or without renal scar on $^{99m}Tc-DMSA$ scan (P=0.117). 5)There was no significnt difference in positive rate of dipstick(100% vs 91%) and microscopic analysis(100% vs 100%) between two groups with or without vesicoureteral reflux on VCUG. Conclusion : There was no specific relationships between the abnormal urinalysis and the abnormal findings on $^{99m}Tc-DMSA$ scan or VCUG.