Isotope renography in childhood enuresis

Area of Science:

• Pediatric Nephrology
• Nuclear Medicine
• Urology

Background:

• Enuresis is common in children.
• Recent studies suggest potential links between enuresis, urodynamic abnormalities, and vesicoureteric reflux.
• The role of standard nuclear medicine renal studies in evaluating enuretic children needs clarification.

Purpose of the Study:

• To evaluate the utility of standard nuclear medicine renal studies in children with enuresis.
• To determine the incidence of abnormalities in isotope renography among enuretic children, with and without urinary tract infections (UTIs).

Main Methods:

• Retrospective review of 100 children with enuresis who underwent isotope renography between 1981-1989.
• Technetium-99m dimercaptosuccinic acid (Tc99mDMSA) scans for renal size and scarring.
• Tc99m diethylenetriaminepentaacetic acid (Tc99mDTPA) or mercaptoacetyltriglycine (MAG3) renography for excretion and reflux evaluation.

Main Results:

• All 45 children with sterile urine had normal isotope studies.
• Of 55 children with microbiological evidence of UTI, 16 (29%) showed abnormalities on isotope studies.
• Overall, standard nuclear medicine renal studies revealed few abnormalities in patients with monosymptomatic enuresis.

Conclusions:

• Standard nuclear medicine renal studies are generally normal in children with monosymptomatic enuresis.
• The presence of a urinary tract infection (UTI) in enuretic children is associated with a higher incidence of abnormal isotope study findings (29%).
• Further investigation with nuclear medicine renal studies is indicated for enuretic children presenting with concurrent UTIs.