Position of the Dynamic Renal Scintigraphy with the Furosemide Test in the Diagnosis of Obstructive
Uropathies in Childhood
Chroustová D.1, Kolská M.2, Urbanová I.5, Klánová M.5, Kryl P.3, Neubertová K.4, Kotrnoch J.3
Klinika nukleární medicíny FN Královské Vinohrady, Praha1 přednosta MUDr. O. Lang Klinika dětí a dorostu FN Královské Vinohrady, Praha2 přednosta doc. MUDr. J. Lebl, CSc. Oddělení dětské chirurgie FN Královské Vinohrady, Praha3 primář MUDr. P. Kryl Oddělení dětské chirurgie FN Bulovka, Praha4 primář MUDr. V. Chromčák Dětské oddělení FN Bulovka, Praha primář MUDr. M. Fuchs |
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Summary:
Administration of a diuretic substance during dynamic renal scintigraphy is widely accepted as a useful test
for differentiation between mechanical obstruction and functional disorders of the upper urinary tract. The paper
shows the advantages and the pitfalls of thismethod in the diagnosis of subrenal obstruction in the examined group
of patients.
54 children (12 girls and 42 boys) aged 3 weeks - 2 years with suspicion of urinary tract obstruction according
to sonography were examined in 1999 - 2001. Half of them had repeated examinations to evaluate the development
of obstruction. Dynamic renal scintigraphy using 99mTc-MAG 3 (benzoylmercaptoacetyltriglycrine) was done on
a planar Gamma camera MB 9200 (Gamma Budapest) with the patient in a supine position. The amount of
radioactivity administered was calculated according to the tables of EANM (European Association of Nuclear
Medicine).
Furosemide was usually administered intravenously during 15th - 20th minute of the study, of 0.5 mg/kg.
Mathematical analysis was performed using the programme Octnucline version 3.3 with semiquantitative estimation
of 99mTc-MAG3 blood clearance (tubularmarker) assessing separate function of the kidneys (%) and half-time
of diuretic excretion (min). Marked signs of subrenal obstruction were detected in 10 children (19 %). Subrenal obstruction could not be
excluded in 13 children (24 %). A negative test for obstruction was recorded in 31 children (57 %). The main
contribution of the method are the determination of separate renal function and the evaluation of subrenal
obstruction by using the furosemide test. The follow-up static images of the kidneys after the basal investigation is
very helpful in the evaluation of the equivocal findings of obstruction.
Conservative treatment predominated in the examined group of patients, especially in children with equivocal
findings of obstruction. Dynamic renal scintigraphy with the furosemide test is very important in the diagnosis of
obstructive uropathies in newborns and infants.
Key words:
dynamic renal scintigraphy using 99mTc-MAG 3, furosemide test, uropathy, childhood
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