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Overall and single-kidney clearance in children with urinary tract infection and damaged kidneys
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.
Unlabelled:
The overall and single-kidney clearance in children with acute urinary tract infection was investigated retrospectively using the combination of the relative 99mTc-dimercaptosuccinic acid (DMSA) uptake and the 51Cr-ethylenediaminetetraacetic acid clearance.
Methods:
There were 180 patients with both normal kidneys, 56 with clear unilateral abnormalities on DMSA scintigraphy and 11 with two abnormal kidneys. Half of the patients were younger than 2 y, and because of the progressive maturation of the renal function, they were not considered in the analysis of the absolute overall and single-kidney clearance; nevertheless, they were included in the analysis of the relative DMSA percentage uptake.
Results:
When only one kidney was affected on DMSA scintigraphy, the clearance of the affected kidney was lower than on the normal side and often abnormally low. In these unilaterally affected kidneys, contralateral compensation mechanisms tended to occur, resulting in preservation of overall clearance. This compensation was probably not present only on the contralateral side. On the abnormal side, the clearance was normal in about half of the cases, probably because of intrarenal compensation occurring in regions not damaged by the infection. In addition to these compensation mechanisms, hyperfiltration was probably present in many cases of acute urinary tract infection with intact or unilaterally damaged kidneys.