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DMSA scintigraphy in renal duplex system
1Department of Pediatric Surgery, University of Lund, Sweden.
Insights
DMSA scintigraphy effectively assesses renal function in children with duplex systems, identifying severe damage to guide surgical decisions. This imaging technique is crucial for managing kidney abnormalities in pediatric patients.
Area of Science:
- Pediatric Nephrology
- Diagnostic Imaging
- Urology
Background:
- Renal duplex systems are congenital anomalies affecting kidney development.
- Accurate assessment of renal parenchymal function is vital for managing these conditions.
Purpose of the Study:
- To evaluate the utility of DMSA scintigraphy in assessing renal parenchymal function in children with duplex systems.
- To correlate DMSA findings with management and surgical outcomes.
Main Methods:
- Retrospective analysis of 40 children with renal duplex systems over 4 years.
- DMSA scintigraphy performed on 52 duplicated kidneys across various age groups.
- Correlation of scintigraphic findings with surgical interventions.
Main Results:
- DMSA revealed varying degrees of parenchymal damage in duplicated kidneys, with 23 cases showing severely deteriorated function (0-14% of total renal function).
- Upper moiety dysfunction was noted in 15 cases, lower pole in 9, and both in one.
- All 23 cases with severe damage underwent surgery (heminephrectomy or nephrectomy).
Conclusions:
- DMSA scintigraphy is invaluable for assessing differential renal function in duplex systems.
- This assessment aids in surgical decision-making for pediatric patients with renal duplex anomalies.
Abstract:
During a 4-year period 40 children (13 boys and 27 girls) with renal duplex system were examined with DMSA scintigraphy. The age at the investigation varied from 18 days to 9 years, mean 2.5 years. Duplicated system existed in 52 kidneys, bilaterally in 12 cases, right-sided in 10 and left-sided in 18 cases. The renal DMSA scintigraphy of the 52 duplicated kidneys revealed insignificant parenchymal damage in 19 kidneys. Moderate parenchymal damage existed in 10 kidneys. In the remaining 23 kidneys, severely deteriorated function of the upper moiety was found in 15 cases and of the lower pole in 9 cases, as both moieties were affected in one kidney. The function of the severely deteriorated moiety varied between 0% and 14%, mean 5.7% of the total renal function. All the 23 cases with severely deteriorated function were operated upon, 22 with heminephrectomy and one with nephrectomy. The assessment of parenchymal function of the separate parts of the kidney with duplex system by DMSA scintigraphy is of great value in the decision of management and surgical procedure.