The Spectrum of Parenchymal Changes in Kidneys Affected by Intrarenal Reflux, Diagnosed by Contrast-Enhanced Voiding Urosonography and DMSA Scan
PurposeTo describe the parenchymal defects in kidneys with intrarenal reflux (IRR) diagnosed using contrast-enhanced voiding urosonography (ceVUS) and 99mTc-DMSA scintigraphy (DMSA scan).Materials and MethodsA group of 186 uretero-renal units (URUs) was analyzed using ceVUS and DMSA scans: 47 withou...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-07-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2022.886112/full |
| _version_ | 1811219139897851904 |
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| author | Ana Simičić Majce Adela Arapović Vesna Čapkun Dubravka Brdar Marko Brekalo Ileana Zebić Ana Barić Ante Punda Ante Punda Mirna Saraga-Babić Katarina Vukojević Marijan Saraga Marijan Saraga |
| author_facet | Ana Simičić Majce Adela Arapović Vesna Čapkun Dubravka Brdar Marko Brekalo Ileana Zebić Ana Barić Ante Punda Ante Punda Mirna Saraga-Babić Katarina Vukojević Marijan Saraga Marijan Saraga |
| author_sort | Ana Simičić Majce |
| collection | DOAJ |
| description | PurposeTo describe the parenchymal defects in kidneys with intrarenal reflux (IRR) diagnosed using contrast-enhanced voiding urosonography (ceVUS) and 99mTc-DMSA scintigraphy (DMSA scan).Materials and MethodsA group of 186 uretero-renal units (URUs) was analyzed using ceVUS and DMSA scans: 47 without vesicoureteral reflux (VUR) (group A) and 139 with VURs, comprising 73 VURs without (group B), and 66 with IRR (group C). VURs included non-dilating (grades I–II), mildly non-dilating (grade III), and non-dilating (grades IV–V) grades. The parenchymal changes were analyzed using a DMSA scan.ResultsThe median age for VUR diagnosis was 16.5 months in girls, and 8.5 months in boys (Z = 3.9; p = 0.001). IRR occurred in 51.4% of boys and in 25.9% of girls (χ2 = 12.4; p < 0.001). The non-dilating VUR occurred in 44% of boys and 24.1% of girls (χ2 = 7.7; p = 0.005). IRRs characterized upper and lower renal segments (81.8 and 63.6%) and middle segments (33.3%). Both incidence and increase in IRR correlated with the grade of VUR (p < 0.001). The incidence of reduced DMSA signal was statistically different among groups A + B and C, but not between groups A and B (χ2 = 32.2; p < 0.001). No statistically significant relationship existed between the reduced DMSA signal and the grade of VUR in group C. The reduced DMSA signal appeared in 9.9% positions in kidneys from group A, 14% from group B, and 32% from group C. Out of all 118 IRRs, 38.1% had reduced and 61.9% had normal DMSA signal. Among 11 parenchymal scars found in all three groups, 2 belonged to group B, 9 to group C, while group A had no scars.ConclusionThe parenchymal changes are the most prominent in the group with IRR, but they do not significantly differ among kidneys with different grades of VUR. VURs of higher grades are associated with a higher incidence of IRR and early clinical presentation. Scars can also appear in lower-grade VURs accompanied by IRR. Boys with VUR have earlier clinical presentation than girls, as they have significantly higher grades of VUR with a higher proportion of IRRs. Therefore, we suggest a subdivision of VURs into those with IRR and abundant parenchymal damage, and those without IRR and less parenchymal damage. |
| first_indexed | 2024-04-12T07:20:16Z |
| format | Article |
| id | doaj.art-3a5d110db8f34ec0b75e271a89778ac7 |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-04-12T07:20:16Z |
| publishDate | 2022-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-3a5d110db8f34ec0b75e271a89778ac72022-12-22T03:42:20ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602022-07-011010.3389/fped.2022.886112886112The Spectrum of Parenchymal Changes in Kidneys Affected by Intrarenal Reflux, Diagnosed by Contrast-Enhanced Voiding Urosonography and DMSA ScanAna Simičić Majce0Adela Arapović1Vesna Čapkun2Dubravka Brdar3Marko Brekalo4Ileana Zebić5Ana Barić6Ante Punda7Ante Punda8Mirna Saraga-Babić9Katarina Vukojević10Marijan Saraga11Marijan Saraga12Department of Pediatrics, University Hospital Split, Split, CroatiaDepartment of Pediatrics, University Hospital Split, Split, CroatiaDepartment of Nuclear Medicine, University Hospital Split, Split, CroatiaDepartment of Nuclear Medicine, University Hospital Split, Split, CroatiaDepartment of Nuclear Medicine, University Hospital Split, Split, CroatiaDepartment of Nuclear Medicine, University Hospital Split, Split, CroatiaDepartment of Nuclear Medicine, University Hospital Split, Split, CroatiaDepartment of Nuclear Medicine, University Hospital Split, Split, CroatiaSchool of Medicine, University of Split, Split, CroatiaDepartment of Anatomy, Histology and Embryology, School of Medicine, University of Split, Split, CroatiaDepartment of Anatomy, Histology and Embryology, School of Medicine, University of Split, Split, CroatiaDepartment of Pediatrics, University Hospital Split, Split, CroatiaSchool of Medicine, University of Split, Split, CroatiaPurposeTo describe the parenchymal defects in kidneys with intrarenal reflux (IRR) diagnosed using contrast-enhanced voiding urosonography (ceVUS) and 99mTc-DMSA scintigraphy (DMSA scan).Materials and MethodsA group of 186 uretero-renal units (URUs) was analyzed using ceVUS and DMSA scans: 47 without vesicoureteral reflux (VUR) (group A) and 139 with VURs, comprising 73 VURs without (group B), and 66 with IRR (group C). VURs included non-dilating (grades I–II), mildly non-dilating (grade III), and non-dilating (grades IV–V) grades. The parenchymal changes were analyzed using a DMSA scan.ResultsThe median age for VUR diagnosis was 16.5 months in girls, and 8.5 months in boys (Z = 3.9; p = 0.001). IRR occurred in 51.4% of boys and in 25.9% of girls (χ2 = 12.4; p < 0.001). The non-dilating VUR occurred in 44% of boys and 24.1% of girls (χ2 = 7.7; p = 0.005). IRRs characterized upper and lower renal segments (81.8 and 63.6%) and middle segments (33.3%). Both incidence and increase in IRR correlated with the grade of VUR (p < 0.001). The incidence of reduced DMSA signal was statistically different among groups A + B and C, but not between groups A and B (χ2 = 32.2; p < 0.001). No statistically significant relationship existed between the reduced DMSA signal and the grade of VUR in group C. The reduced DMSA signal appeared in 9.9% positions in kidneys from group A, 14% from group B, and 32% from group C. Out of all 118 IRRs, 38.1% had reduced and 61.9% had normal DMSA signal. Among 11 parenchymal scars found in all three groups, 2 belonged to group B, 9 to group C, while group A had no scars.ConclusionThe parenchymal changes are the most prominent in the group with IRR, but they do not significantly differ among kidneys with different grades of VUR. VURs of higher grades are associated with a higher incidence of IRR and early clinical presentation. Scars can also appear in lower-grade VURs accompanied by IRR. Boys with VUR have earlier clinical presentation than girls, as they have significantly higher grades of VUR with a higher proportion of IRRs. Therefore, we suggest a subdivision of VURs into those with IRR and abundant parenchymal damage, and those without IRR and less parenchymal damage.https://www.frontiersin.org/articles/10.3389/fped.2022.886112/fullvesico ureteral refluxintrarenal refluxcontrast-enhanced voiding urosonographyradioisotope scanningchildren |
| spellingShingle | Ana Simičić Majce Adela Arapović Vesna Čapkun Dubravka Brdar Marko Brekalo Ileana Zebić Ana Barić Ante Punda Ante Punda Mirna Saraga-Babić Katarina Vukojević Marijan Saraga Marijan Saraga The Spectrum of Parenchymal Changes in Kidneys Affected by Intrarenal Reflux, Diagnosed by Contrast-Enhanced Voiding Urosonography and DMSA Scan Frontiers in Pediatrics vesico ureteral reflux intrarenal reflux contrast-enhanced voiding urosonography radioisotope scanning children |
| title | The Spectrum of Parenchymal Changes in Kidneys Affected by Intrarenal Reflux, Diagnosed by Contrast-Enhanced Voiding Urosonography and DMSA Scan |
| title_full | The Spectrum of Parenchymal Changes in Kidneys Affected by Intrarenal Reflux, Diagnosed by Contrast-Enhanced Voiding Urosonography and DMSA Scan |
| title_fullStr | The Spectrum of Parenchymal Changes in Kidneys Affected by Intrarenal Reflux, Diagnosed by Contrast-Enhanced Voiding Urosonography and DMSA Scan |
| title_full_unstemmed | The Spectrum of Parenchymal Changes in Kidneys Affected by Intrarenal Reflux, Diagnosed by Contrast-Enhanced Voiding Urosonography and DMSA Scan |
| title_short | The Spectrum of Parenchymal Changes in Kidneys Affected by Intrarenal Reflux, Diagnosed by Contrast-Enhanced Voiding Urosonography and DMSA Scan |
| title_sort | spectrum of parenchymal changes in kidneys affected by intrarenal reflux diagnosed by contrast enhanced voiding urosonography and dmsa scan |
| topic | vesico ureteral reflux intrarenal reflux contrast-enhanced voiding urosonography radioisotope scanning children |
| url | https://www.frontiersin.org/articles/10.3389/fped.2022.886112/full |
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