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Renal pathology and the 99mTc-DMSA image before and after treatment of the evolving pyelonephritic scar: an
R A Risdon1, M L Godley, I Gordon
1Institute of Child Health, London, United Kingdom.
Abstract:
This study reports the effects of 3-weeks' antimicrobial treatment on the pathology and appearance of the 99mTc-DMSA renal image in piglets with pyelonephritis induced by a combination of vesicoureteral reflux (VUR) and urinary infection. Before treatment, either photon-deficient (B1, B2) or photon-absent (C) scintigraphic abnormalities were present in the refluxing kidney in all 22 animals examined. All (100%) of the initially B1 and the majority (71%) of B2 photon deficient defects resolved with treatment, leaving only insignificant residual pathologic lesions. Conversely almost all (93%) of the C photon-absent scintigraphic abnormalities persisted after treatment and were always associated with significant scarred or cratered pathologic lesions in the refluxing kidney at sacrifice.
Insights
Antimicrobial treatment effectively resolved mild kidney defects in piglets with pyelonephritis and vesicoureteral reflux (VUR). However, severe defects persisted, indicating permanent kidney damage despite antibiotic therapy.
Area of Science:
- Pediatric Nephrology
- Nuclear Medicine
- Veterinary Pathology
Background:
- Pyelonephritis in piglets, often caused by vesicoureteral reflux (VUR) and urinary infection, can lead to kidney damage.
- 99mTc-DMSA scintigraphy is a key imaging modality for assessing renal scarring in pyelonephritis.
Purpose of the Study:
- To evaluate the impact of antimicrobial treatment on pyelonephritis-related kidney pathology and 99mTc-DMSA renal imaging findings in a piglet model.
- To differentiate the treatment response based on the severity of initial scintigraphic abnormalities.
Main Methods:
- Induction of pyelonephritis in piglets via VUR and bacterial infection.
- Administration of a 3-week antimicrobial treatment course.
- Assessment of renal pathology and 99mTc-DMSA scintigraphy before and after treatment.
Main Results:
- 100% resolution of photon-deficient defects (B1) and 71% resolution of moderate defects (B2) after treatment.
- Persistence of photon-absent defects (C) in 93% of cases, correlating with significant renal scarring.
- Mild defects showed resolution, while severe defects indicated irreversible kidney damage.
Conclusions:
- Antimicrobial therapy is effective in resolving mild renal lesions associated with pyelonephritis and VUR.
- Severe, photon-absent defects on 99mTc-DMSA scans signify irreversible kidney damage and scarring, unresponsive to antibiotics.
- 99mTc-DMSA scintigraphy effectively distinguishes between reversible and irreversible kidney damage in pyelonephritis.