Meliha KORKMAZ, Rahime ORAK, Aylin AKBULUT, Gökhan KOCA, Hasan Ikbal ATILGAN, Murat SADIÇ

RADYONÜKLİD SİSTOGRAFİ İLE VEZİKOÜRETERAL REFLÜ DÜŞÜNÜLEN PEDİATRİK OLGULARDA KORTİKAL RENAL SİNTİGRAFİ DEGERLENDİRİLMESİ

AMAÇ: Vezikoüreteral reflü VUR üriner enfeksiyon geçiren çocukların %21-57’unda saptanmakta olup, kronik böbrek yetmezliğine kadar uzanabilen önemli sonuçları vardır. Vezikoüreteral reflü olan çocukların tanı ve takibinde radyonüklid sistografi RNS etkin ve güvenilir bir tanı yöntemidir. Bu çalışmada RNS ile tanı konulan VUR pozitif ve negatif çocuklarda renal parankim hasar gelişmesini Tc99m-DMSA sintigrafisi ile değerlendirdik.GEREÇ VE YÖNTEMLER: Tekrarlayan üriner sistem enfeksiyonu ile başvuran 196 çocuğa ait 121 kız, 75 erkek; 3 ay-13 yaş aralığında toplam 392 adet renal unite direkt veya indirekt RNS sonrasında renal kortikal sintigrafi ile değerlendirildi. Tüm hastalar klinik olarak değerlendirildi ve kreatinin, idrar analizleri ve idrar kültürleri bakıldı. Ayrıca tüm hastaların renal Ultrasonları US yapıldı. İncelenen böbrekler 4 gruba ayrıldı. Birinci grupta hem RNS hem DMSA sonuçları normal, 2.ci grupta hem RNS hem DMSA sonuçları anormal, 3.cü grupta RNS sonucu anormal ancak DMSA sonucu normal ve 4.cü grupta RNS sonucu normal ancak DMSA sonucu anormal böbrekler alındı. BULGULAR: 69 hastada 77 renal ünitte sintigrafik olarak VUR tesbit edildi. Otuzbeş renal ünitte grade 1, 13 renal ünitte grade 2, 13 renal ünitte grade 3 VUR olup, 8 hastada VUR bilateraldi. Birinci grupta 212 %54.1 , 2.ci grupta 58 % 14.8 , 3.ncü grupta 98 % 25.0 ve 4.cü grupta 24 renal ünite % 6.1 bulundu. Renal US 131 böbrekte %33.4 anormal olarak değerlendirildi.SONUÇ: RNS sonuçları anormal hastalarla Tc-99m DMSA sintigrafisi normal ve anormal olan hastalar karşılaştırıldığında, anormal olan hastalar daha sıklıkla pozitif olarak bulundu. US sonuçları ile RNS sonuçları normal hastalarla veya anormal hastalar arasında anlamlı ilişki bulunamadı. Gerek VUR pozitif gerekse VUR negatif hastalarin tanılarında Tc99m DMSA sintigrafisi, RNS ve renal US birbirlerini tamamlayıcı olarak kullanılmalıdırlar

Anahtar Kelimeler:

Vezikoüreteral reflü, Radyonüklid Sistografi, Tc99m-DMSA

THE EVALUATION OF RENAL CORTICAL SCINTIGRAPHY IN VESICOURETERAL REFLUX SUSPECTED PEDIATRIC PATIENTS WITH RADIONUCLIDE CYSTOGRAPHY

OBJECTIVE: Vesicoureteral reflux VUR can be diagnosed in 21-57 % of children with urinary tract infection and may have important consequences leading to chronic renal failure. Radionuclide cystography RNC is an effective and reliable method in the diagnosis and follow up of children with VUR. In this study, we evaluated renal parenchymal damage with Tc99m-DMSA scintigraphy in the VUR positive and negative children diagnosed with RNC.MATERIAL AND METHODS: A total of 392 renal units in 121 girls and 75 boys; age range, 3 months -13 years, were evaluated with direct or indirect RNC and renal cortical scintigraphy who were referred to Nuclear Medicine Department for recurrent urinary tract infection. All the patients were subjected to clinical assessment, laboratory investigation urine analysis, creatinine and urine culture and renal ultrasonography analysis US . Patients kidneys were evaluated in 4 groups; in the 1st group kidneys with both RNC and DMSA results were normal, 2nd group neither RNC nor DMSA results were normal, 3rd group RNC results were abnormal but DMSA results were normal and the 4th group RNC results were normal but DMSA results were normal.RESULTS: Positive VUR was scintigraphically evident in 69 patients with 77 renal units. Thirty-five kidneys had grade 1 , 13 kidneys had grade 2, 13 kidneys had grade 3 VUR and 8 patients had bilateral VUR . In the first group, there were 212 renal unites 54.1% , in 2nd group there were 58 renal unites 14.8 % , in the 3rd group there were 98 renal unites 25.0 % and in the 4th group there were 24 renal unites 6.1 % . US findings were abnormal in 131 33.4 % kidney units. CONCLUSION: In the comparision of RNC abnormal kidneys with Tc-99m DMSA scintigraphy normal and abnormal kidneys: abnormal kidneys were more commonly positive. There was no statistical difference of US for parenchyma pathology between RNC positive and RNC negative cases. Renal scanning with Tc99m DMSA, RNC and renal US should be complementary both in VUR positive and VUR negative cases

Keywords:

Vesicoureteral reflux VUR, Radionuclide cystography RNC, Tc-99m DMSA,

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