Overall and single-kidney clearance in children with urinary tract infection and damaged kidneys

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F Arnello1, H R Ham, M Tondeur

  • 1Department of Nuclear Medicine, Academic Hospital, Vrije Universiteit Brussel, Brussels, Belgium.

Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine
|February 6, 1999
PubMed

Insights

Children with acute urinary tract infections often show preserved overall kidney function due to compensatory mechanisms, even with unilateral kidney damage detected by technetium-99m dimercaptosuccinic acid (DMSA) scans.

Area of Science:

  • Pediatric Nephrology
  • Nuclear Medicine Imaging
  • Renal Physiology

Background:

  • Acute urinary tract infections (UTIs) are common in children.
  • Renal scarring and impaired function can result from UTIs.
  • Assessing single-kidney function is crucial for managing pediatric UTIs.

Purpose of the Study:

  • To investigate overall and single-kidney clearance in children with acute UTIs.
  • To evaluate the relationship between technetium-99m dimercaptosuccinic acid (DMSA) uptake and actual kidney clearance.
  • To understand compensatory mechanisms in unilateral kidney damage due to UTI.

Main Methods:

  • Retrospective analysis of 180 children with normal kidneys, 56 with unilateral abnormalities, and 11 with bilateral abnormalities on DMSA scintigraphy.
  • Utilized 51Cr-ethylenediaminetetraacetic acid (EDTA) clearance for absolute overall and single-kidney clearance measurements.
  • Relative DMSA percentage uptake was analyzed, including younger children (<2 years) not included in absolute clearance analysis.

Main Results:

  • Unilaterally affected kidneys showed lower clearance than normal kidneys, often abnormally low.
  • Contralateral compensatory mechanisms preserved overall kidney clearance in most unilateral cases.
  • Intrarenal compensation and hyperfiltration likely contributed to normal or near-normal clearance in affected kidneys and overall function.

Conclusions:

  • Children with acute UTIs can maintain overall kidney function despite unilateral damage due to compensatory mechanisms.
  • DMSA scintigraphy findings correlate with functional deficits, but compensatory mechanisms can mask the full extent of impairment.
  • Further investigation into hyperfiltration and intrarenal compensation is warranted in pediatric UTIs.
Abstract

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