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Overall and Single-Kidney Clearance in Children with Urinary Tract Infection and Damaged Kidneys

Departments of Nuclear Medicine, Academic Hospital, Vrije Universiteit Brussel and Centre Hospitalo Universitaire St. Pierre, Brussels, Belgium
San Juan de Dios Hospital, Santiago, Chile

Correspondence: For correspondence or reprints contact: Amy Piepsz, MD, AZ VUB, Department of Nuclear Medicine, Laarbeeklaan 101, B-1090 Brussels, Belgium.

ABSTRACT

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.

Key Words: clearance • ^99mTc-dimercaptosuccinic acid • ⁵¹Cr-ethylenediaminetetraacetic acid • urinary tract infection • children