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[Radioisotopic quantification of kidney function using Tc-99m-DMSA. Comparison with creatinine clearance in children
Insights
Technetium Tc 99m dimercaptosuccinic acid (DMSA) scans accurately quantify renal function in children with a single kidney. DMSA uptake correlates well with creatinine clearance, aiding in differential renal function assessment.
Area of Science:
- Pediatric Nephrology
- Nuclear Medicine
- Diagnostic Imaging
Background:
- Accurate assessment of differential renal function is crucial in pediatric patients with renal abnormalities.
- Technetium Tc 99m dimercaptosuccinic acid (DMSA) scintigraphy is a common imaging modality for evaluating renal morphology and function.
- Quantifying renal function with DMSA in children, especially those with a single kidney, requires validation against established markers.
Purpose of the Study:
- To evaluate the accuracy of Technetium Tc 99m dimercaptosuccinic acid (DMSA) renal uptake for quantifying renal function in children with a single kidney.
- To establish the correlation between DMSA renal uptake and creatinine clearance in this pediatric population.
- To determine the role of DMSA scintigraphy in assessing differential renal function.
Main Methods:
- A cohort of 16 children with a single kidney, aged two months to fourteen years, was studied.
- Renal function was assessed by comparing DMSA renal uptake (measured 7 hours post-injection and normalized) with creatinine clearance.
- Statistical analysis, including Pearson's correlation, was used to determine the relationship between the two measures.
Main Results:
- A significant positive correlation was observed between creatinine clearance and DMSA renal uptake (Pearson's r = 0.866, p < 0.01).
- Normal ranges for creatinine clearance (80-120 ml/min/1.73 m²) corresponded to normal DMSA renal uptake values (36-60%).
- DMSA renal uptake was found to accurately reflect split renal creatinine clearance in cases of asymmetrical renal impairment.
Conclusions:
- Technetium Tc 99m DMSA scintigraphy is a reliable method for assessing differential renal function in children with a single kidney.
- DMSA uptake measurement is a simpler and effective alternative to creatinine clearance for evaluating split renal function.
- DMSA scintigraphy should be considered an important tool in the management of pediatric renal conditions requiring functional assessment.
Abstract:
To assess the accuracy of renal function quantification with Tc 99m-DMSA in children, we compared DMSA renal uptake and creatinine clearance in 16 cases of children with single kidney. The age of the patients ranged from two month to fourteen years. DMSA renal uptake was measured 7 hours after injection and was normalized in percent of the injected activity. A significant correlation was found between creatinine clearance and DMSA uptake (Pearson's r = 0.866, p less than 0.01). Normal creatinine clearance in children (80 to 120 ml/min-1 X 1.73 m-2) allowed determination of normal renal uptake (36 to 60%). This study indicates that in cases of asymmetrical renal impairment renal uptake reflects split renal creatinine clearance. Since the former is much easier to measure, DMSA should play an important role in the evaluation of differential renal function.