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Diuretic MAG3 Scintirenography in Children with HIV Nephropathy: Diffuse Parenchymal Dysfunction

Division of Nuclear Medicine, Department of Radiology, and Division of Pediatric Nephrology, Department of Pediatrics, University of Miami School of Medicine and Jackson Memorial Hospital, Miami, Florida

Correspondence: For correspondence or reprints contact: George N. Sfakianakis, MD, Division of Nuclear Medicine (D-57), University of Miami School of Medicine, P.O. Box 016960, Miami, FL 33101.

ABSTRACT

HIV nephropathy (HIVN) is prevalent in 15%–56% of HIV-infected children and induces mild to severe progressive nephropathy. Methods: A total of 33 renal diuretic scintirenographic studies with ^99mTc-mercaptoacetyltriglycine (MAG3) were reviewed and analyzed from 23 HIV pediatric patients, 21 of whom had HIVN with varying degrees of renal impairment. Results were compared with 10 studies of control patients of matching ages. Visual interpretation of images and renograms as well as semiquantitative analyses were performed. Variables compared were size of kidneys, time of peak and one-half peak activities, residual (or retained) cortical activity at 20 min, ratio of cortical activity at 2.5–20 min, and ratio of kidney activity to kidney plus background activity at 2 min. The results of MAG3 renal studies were also compared with laboratory data pertaining to creatinine clearance in all patients and with sonography in 17 patients. Results: In most patients with HIVN (18/21), the kidneys were larger than normal, with a diffuse parenchymal dysfunction (decreased uptake, slow processing, and increased retention of activity) and flat renograms, findings similar to those observed in other diffuse parenchymal diseases. In all patients with HIVN, semiquantitative analysis (paired f test) showed statistically significant differences from control patents for all variables. On ANOVA, a statistically significant correlation was found between most scintigraphic parameters and the severity of renal impairment. Of the 17 concurrent sonographic studies in HIVN patients, 7 showed no abnormalities, whereas the results of scinttgraphy were abnormal. Conclusion: Diuretic MAG3 scintirenography shows nonspecific diffuse parenchymal dysfunction in pediatric patients with HIVN. Such dysfunction may provide corroborative evidence of HIVN and should be recognized when the test is performed for standard indications. Further work is necessary to prove that the test has indeed the high sensitivity and good correlation with the severity of HIVN suggested in this population; the test may be useful to follow up the progression of disease and the effect of treatment.

Key Words: ^99mTc-mercaptoacetyltriglycine • HIV nephropathy • pediatrics • scintirenography • AIDS

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				G. N. Sfakianakis, F. Cavagnaro, G. Zilleruelo, C. Abitbol, B. Montane, M. Georgiou, S. Ezuddin, W. Mallin, E. Sfakianakis, and J. Strauss Diuretic MAG3 Scintigraphy (F0) in Acute Pyelonephritis: Regional Parenchymal Dysfunction and Comparison with DMSA J. Nucl. Med., December 1, 2000; 41(12): 1955 - 1963. [Abstract] [Full Text] [PDF]