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Sensitivity of ultrasonography in detecting renal parenchymal defects in children
Tanja Kersnik Levart1, Anton Kenig, Jure J Fettich
1Department of Pediatric Nephrology, University Medical Center, Stare pravde 4, 1000 Ljubljana, Slovenia. Tanja.Kersnik@guest.arnes.si
Insights
Ultrasonography (US) effectively detects clinically significant renal parenchymal defects (RPD) in children, similar to DMSA scans. This suggests US can replace DMSA, reducing radiation exposure and costs.
Area of Science:
- Pediatric Nephrology
- Diagnostic Imaging
- Renal Pathology
Background:
- Renal parenchymal defects (RPD) in children are a significant risk factor for chronic renal failure.
- 99mTc-dimercaptosuccinic acid (DMSA) renal scans are standard for RPD detection, but may be overly sensitive.
- Ultrasonography (US) sensitivity for clinically significant RPD requires further evaluation.
Purpose of the Study:
- To assess the sensitivity of US in identifying children with clinically significant RPD.
- To compare US detection of RPD with DMSA findings across various grades.
- To determine if US can reliably detect RPD that impact renal function.
Main Methods:
- Retrospective analysis of 89 children with abnormal DMSA scans.
- Repeat DMSA, US, and renal function tests performed at least 1 year post-initial DMSA.
- Correlation of RPD extent (DMSA vs. US) with renal function parameters.
Main Results:
- US detected clinically significant RPD in all 5 patients with diminished renal function.
- US identified clinically insignificant RPD in 71.6% (48/67) of cases.
- US demonstrated comparable sensitivity to DMSA for clinically significant RPD.
Conclusions:
- US is sufficiently sensitive for detecting clinically significant RPD in children.
- US can potentially replace DMSA for RPD evaluation, offering benefits like reduced radiation exposure, lower costs, and increased availability.
- US provides a valuable alternative for monitoring RPD and assessing renal function in pediatric patients.
Abstract:
Renal parenchymal defects (RPD) -- scars, hypoplasia/dysplasia -- in children are a major risk factor for chronic renal failure. Most authors would agree that RPD should be detected and followed by a 99mTc-dimercaptosuccinic acid renal scan (DMSA), as ultrasonography (US) does not seem to be sensitive enough for this purpose. However, it might well be that DMSA is too sensitive and detects RPD that are too small to be clinically significant. The purpose of this study was to evaluate the sensitivity of US in identifying patients with clinically significant RPD and in detecting RPD of various grades as seen by DMSA. In 89 children with abnormal DMSA, a second DMSA, US, and other tests for evaluating renal function were performed at least 1 year after the first DMSA. The extent of RPD detected by DMSA and US was correlated with renal function parameters. In all 5 patients with diminished renal function, RPD were detected by both DMSA scan and US. In addition, US detected clinically insignificant RPD in 48 of 67 cases (71.6%). The present study has shown that, compared with DMSA, US is sensitive enough to detect clinically significant RPD in children. The substitution of DMSA with US would be beneficial, as this would eliminate radiation exposure, reduce costs, and increase availability.