• 대한핵의학회:학술대회논문집
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• 1989.06a
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• pp.136.1-136.1
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• 1989

• Childhood Kidney Diseases
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• v.17 no.2
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• pp.110-116
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• 2013

Purpose: The $^{99m}Tc$-Dimercaptosuccinic acid (DMSA) renal scan is used primarily for the diagnosis of renal scarring and acute pyelonephritis in children with urinary tract infections (UTI). This study aimed to evaluate clinical differences based on the positive or negative results of DMSA scans and kidney ultrasonography (US) in pediatric UTI. Method: We retrospectively reviewed 142 pediatric patients with UTI who were admitted to Myongji Hospital from January 2004 to December 2012. We performed a comparative analysis of clinical parameters such as age, sex, white blood cell (WBC) count, neutrophil count, blood urea nitrogen (BUN) level, creatinine (Cr) level, C-reactive protein (CRP) level, and durations of hospitalization and fever, grouped by the results of the DMSA scans and kidney US. Results: The mean age of the patients was $33.8{\pm}48.3$ months, and 78 (55%) were male. Fifty-two patients had abnormal DMSA findings, and 71 patients had abormal kidney US findings (test positive groups). In the DMSA scan positive group, there were significant differences in age, WBC counts, neutrophil counts, CRP level, BUN level, Cr level, hospitalization duration, number of abnormal findings on kidney US, and incidence of vesicoureteral reflux (VUR) compared with the scan negative group. The kidney US positive group had significant differences in age, neutrophil count, CRP level, BUN level, Cr level, hospitalization duration, number of abnormal findings on the DMSA scans, and more frequent VUR compared with the US negative group. Conclusion: Our data suggest that there were no major differences in clinical parameters based on the results of the DMSA scans compared with kidney US in pediatric UTI. However, as kidney US and DMSA scan were performed to predict VUR, the sensitivity and negative predictive value was increased.

• The Korean Journal of Nuclear Medicine
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• v.34 no.2
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• pp.135-143
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• 2000

Purpose: As vesicoureteral reflux (VUR) could lead to renal functional deterioration when combined with urinary tract infection, we need to decide whether operative anti-reflux treatment should be performed at the time of diagnosis of VUR. Predictive value of radioisotope voiding cystography (RIVCG) for renal outcome was tested. Materials and Methods: In 35 children (18 males, 17 females), radiologic voiding cystoure-thrography (VCU), RIVCG and DMSA scan were performed. Change in renal function was evaluated using the follow-up DMSA scan, ultrasonography, and clinical information. Discriminant analysis was performed using individual or integrated variables such as reflux amount and extent at each phase of voiding on RIVCG, in addition to age, gender and cortical defect on DMSA scan at the time of diagnosis. Discriminant function was composed and its performance was examined. Results: Reflux extent at the filling phase and reflux amount and extent at postvoiding phase had a significant prognostic value. Total reflux amount was a composite variable to predict prognosis. Discriminant function composed of reflux extent at the filling phase and reflux amount and extent at postvoiding phase showed better positive predictive value and specificity than conventional reflux grading. Conclusion: RIVCG could predict renal outcome by disclosing characteristic reflux pattern during various voiding phases.

• Childhood Kidney Diseases
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• v.5 no.1
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• pp.36-42
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• 2001

Purpose : Vesicoureteral reflux is the most commonly inherited disease detected in children with urinary tract infection. The incidence of vesicoureteral reflux among siblings of children with known vesicoureteral reflux is 8$\%$ to 45$\%$ according to different authors. Family screening of a patient with vesicoureteral reflux is important in order to prevent reflux nephropathy. The purpose of this study is to determine the incidence of vesicoureteral reflux in asymptomatic family of children with vesicoureteral reflux and the factors which influence the family history. Methods : The study group consisted of 27 families of patients with vesicoureteral reflux. The total number in the group were 79 persons. BUN, Cr, urineanalysis, voidingcystourethrography(VCUG) and 99mTc -dimercaptosuccinic acid(DMSA) renal scan were performed oil tile siblings. As for tile parents the same tests were performed except the VCUG. Results : The abnormality was detected in 7 of 27 families(25.9$\%$). Vesicoureteral reflux was detected in 5 of 20 siblings and renal scar ns detected in 3 of 32 parents. In children with vesicoureteral reflux, renal scar was detected in 24 of 32 children. Between the group with the abnormality in its family(Group A) and the group without the abnormality in its family(Group B), There was no difference of creatinine clearance between two groups. More renal scars were detected in group A according to the DMSA(A:100$\%$, B:75$\%$. t-test P<0.05). There was no difference of grade of VCUG between two groups. There was no difference between one site and both sites in two groups. In tile case of tile siblings with vesicoureteral reflux, there was high incidence of renal scar in a patient with vesicoureteral reflux according to the DMSA. Conclusion : It is important to screen vesicoureteral reflux and renal scar in case of urinary tract infection to prevent reflux nephropathy. This study implies that it is necessary to screen the family of a patient with vesicoureteral reflux especially with renal scar. (J, Korean Soc Pediatr Nephrol 5 : 36- 42, 2001)

• Childhood Kidney Diseases
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• v.15 no.2
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• pp.179-183
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• 2011

Abrupt progression of renal scarring associated with vesicoureteral reflux (VUR) is rare in males over 2 years old of age. We report a 5 year old boy with sustained unilateral high grade VUR who experienced abrupt progression of renal scarring; he had a relative renal radionuclide uptake of 38% at 2 years of age that dropped to 8% after three years. Per his parent's wishes, he took prophylactic antibiotics for 25 months after his first febrile urinary tract infection (UTI) at 4 months old without surgical management. One episode of recurrent breakthrough infection occurred at the age of 2 years. This observation reminds us that a recommending surgical management for sustained high grade VUR associated with renal scarring might be needed. Close follow up of DMSA for renal scanning, and long term follow up of patients after the first febrile UTI are important.

• Childhood Kidney Diseases
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• v.12 no.2
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• pp.186-193
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• 2008

Purpose : Intrarenal reflux(IRR) is backflow of urine from the renal pelvis into the collecting ducts. IRR is the main cause of renal injury in children with vesicoureteral reflux (VUR) which leads to renal scars, hypertension, proteinuria, and chronic renal failure. The purpose of our study was to investigate the characteristics of intrarenal reflux. Method : We retrospectively reviewed the medical records of 80 patients who were diagnosed as having grades of III-V VUR from Jan. 2004 to Dec. 2006 in the department of pediatrics in Ajou University Hospital. The patients were divided into two groups according to the presence of IRR on voiding cystoureterogram and compared to each other for the possible factors associated with intrarenal reflux. Results : Among 80 VUR patients, IRR(＋) group comprised 17(21.3%) patients and 27 renal units(23.2%) and revealed younger age, higher grade of VUR, and more proteinuria compared to IRR(-) group. There were no significant difference in gender, laboratory findings and the rate of resolution in VUR or defects on renal scan between two groups. Also, intrarenal reflux mostly corresponded to the same site of photon defects on DMSA scan. Conclusion : We suggest that intrarenal reflux tends to be associated with younger age, higher grade of reflux, more proteinuria with no difference in resolution rate of VUR when compared to the VUR patients without IRR. From this study, we were able to understand the characteristics of intrarenal reflux in children with urinary tract infection.

• Childhood Kidney Diseases
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• v.12 no.1
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• pp.62-69
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• 2008

Purpose: The most concerning issue in children with urinary tract infection(UTI) is the probability of underlying genitourinary anomalies and vesicoureteral reflux (VUR), which is frequently associated with renal scarring and eventually end-stage renal disease. Therefore, voiding cystourethrography(VCUG) is usually recommended at the earliest convenient time for children with UTI. However, VCUG is an invasive procedure that requires catheterization and exposure to X-ray. In this study, we aimed to determine the predictability of clinical, laboratory and imaging parameters for VUR in children with UTI. Methods: Data of children with bacteriologically proven UTI who underwent VCUG were evaluated retrospectively for clinical(age, gender, fever), laboratory(leukocytosis, ESR, CRP, pyuria, blood urea nitrogen, serum creatinine) and imaging(renal ultrasound and DMSA renal scan) findings. First, children with UTI were divided into two groups according to the presence of VUR as non-VUR group and with VUR group, and clinical, laboratory variables were compared between these groups. Second, patients who had VUR were reclassified as low-grade VUR(grade I-II) group and high-grade(grade III-V) VUR group according to grading of VUR, and clinical, laboratory and imaging variables were compared between these groups. Results: Among 410 children with UTI, 137 had VUR and 78 high-grade VUR. Fever, leukocytosis, ESR, CRP, pyuria were associated with VUR. In addition, abnormal findings of ultrasonography and DMSA renal scan were closely related to VUR. However, these clinical and laboratory variable in patients with high grade VUR were not different significantly, compared to those with low-grade VUR group. Conclusion: Fever, leukocytosis, ESR, CRP seems to be potentially useful predictors of VUR in pediatric patients with UTI. In addition, renal ultrasonography and DMSA renal scan findings supported the presence of VUR. Further study of these findings could limit unnecessary VCUG in patients with UTI.

• The Korean Journal of Nuclear Medicine Technology
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• v.14 no.2
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• pp.117-121
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• 2010

Purpose: In nuclear medicine study, there are two methods, preset count method and preset time method, to acquire static images. We usually use preset count method for static image in $^{99m}Tc$-DMSA renal scan, but occasionally use preset time method. In case of using preset count method, we always acquire same counts but it causes a difference of scan time. In case of using preset time method, it takes same scan time to acquire images but it causes different counts. Therefore, the purpose of this study is to investigate any differences of function and formal information in both kidney by acquisition counts Materials and Methods: From January 11, 2010 to March 31, 2010, we analyzed the 30 patients (M: 11, W: 19). who were examined by $^{99m}Tc$-DMSA scan and have one side of functioning kidney relatively between 40~60%. And the patients who have cold and hot region in image were analyzed but we did not accept images of patients when it was hard to divide kidney into cortex. There was no division between subjects and age of subjects is $14.83{\pm}22.07$ old. We used the BrightView gamma camera from PHILIPS. To analyze function and formal of kidney, we used JET stream release 3.0 version from PHILIPS. Using SPSS 12.0 program, we compared descriptive statistics and paired T-test. Images were acquired sequentially in the same parameters, but there are three methods which different from acquisition time and scan time, 100 kcounts, 300 kcounts and 7 minutes method (exceed 300 kcounts). To assess function and formal information of kidney, we measured renal relative function, geometric mean and size of kidney and analyzed each difference. Results: In case of renal relative function in both kidney, 100 kcounts method was $50.52{\pm}3.64%$. 300 kcounts method was $50.38{\pm}3.66%$ and 7 minutes method was $49.91{\pm}3.40%$ and there were no statistical significant differences between each method. In case of geometric mean, 100 kcounts method was $50.08{\pm}3.25%$. 300 kcounts method was $49.89{\pm}3.40%$ and 7 minutes method was $49.91{\pm}3.24%$. And also, there were no statistical significant differences. When comparing size of kidney, 100 kcounts method was $8.23{\pm}1.96$ cm. 300 kcounts method was $8.12{\pm}1.90$ cm and 7 minutes method was $8.35{\pm}1.97$ cm. In case of right kidney, 100 kcounts method was $7.91{\pm}1.88$ cm. 300 kcounts method was $8.12{\pm}1.90$ cm and 7 minutes method was $8.25{\pm}1.96$ cm. From those values, we recognized that there were significant differences each method (p<0.05). Conclusion: From results of this study, there were no statistical differences in renal relative function and geometric mean by acquisition counts. However, in shape of kidney, the more acquisition counts are increasing, the more size of kidney is getting big. And there were statistical significant differences. Therefore, to perform reliable quantitative result, preset count method is more desirable than preset time method. Especially, in case of a follow-up test, if we use preset time method, it will cause differences of formal results in kidney due to acquisition counts each time we examine patients.

• 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.13 no.1
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• pp.33-39
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• 2009

Purpose : Our aim is to reduce the rate of lumbar spinal tapping and voiding cystourethrography (VCUG) in febrile urinary tract infection (UTI) infants less than 3 months of age. Methods : We reviewed the prevalence of UTI, sepsis, meningitis and UTI with bacterial meningitis in febrile infants less than 3 months of age during the period from Jan. 2001 to Jun. 2008. Renal ultrasonography, Technetium-99m dimercaptosuccinic acid (DMSA) renal scan or VCUG were performed in infants with UTI. Infants with UTI were divided into two groups according to the presence of abnormal findings of ultrasonography and DMSA renal scan : group 1-Infants in whom both ultrasonography and DMSA were normal, group 2-Infants in whom ultrasonography or DMSA were abnormal. Prevalence of VUR was compared between the two groups. We followed up the clinical course of patients who had VUR in group 1. Results : Among 1962 Infants, UTI, sepsis and bacterial meningitis were diagnosed in 620 (31.6%), 63 (3.2%), 8 (0.4%) respectively. Lumbar puncture was performed in 413 (66.6%) infants with UTI and we did not detect a case of bacterial meningitis in association. 348 infants with proven UTI were undergone ultrasonography, DMSA, VCUG. In group 1 with 110 infants (31.6%), the presence of VUR was 4 (3.6%). In group 2 with 238 infants (68.4%), the presence of VUR was 51 (21.4%). Abnormal findings of ultrasonography or DMSA renal scan were closely related with high grade VUR. Most of patients with VUR in group1 had good prognosis. Conclusion : Lumbar puncture and VCUG are invasive procedures. Therefore we should decide whether to perform lumbar puncture or VCUG in infants less than 3 months. of age with their first febrile UTI.