Nuclear Imaging in Pediatric Kidney Diseases
Nuclear medicine has played an important role in the management of various renal diseases in children. A wide variety of nephrological conditions can be diagnosed and evaluated using renal scintigraphic methods. Common scans used in Pediatric Kidney Diseases include Tc-99m dimercaptosuccinic acid renal scintigraphy (Tc-99m-DMSA), Tc-99m mercaptoacetyltriglycine (Tc-99m-MAG3) or Tc-99m diethylenetriaminepentaacetic acid (Tc-99m-DTPA) dynamic renal scintigraphy, and radionuclide micturating cystography. These methods can be safely used in children. Most of them do not require sedation or sophisticated equipment.
Renal scintigraphy continues to play an important role in the management of genitourinary disorders, especially with Pediatric Kidney Diseases. However, proper guidelines and protocols need to be followed for accurate interpretation. Clinico-radiological correlation is also essential for the optimum interpretation. Finally, PET-CT/MRI is bound to play a key role and aid in the diagnosis and management of genitourinary conditions in children.
Some of the affected children present with urinary tract infections or an abdominal mass, but most of them remain asymptomatic for a long time. The natural course of HN/HUN in infants and children is variable. In some patients, HN/HUN improves or resolves completely, but in others, it remains stable or gradually gets worse and, depending on the underlying cause and without timely surgical intervention, may result in silent loss of renal function or recurrent episodes of abdominal/flank pain. Therefore, the aim for imaging evaluation of these infants and children should be to identify the kidneys that are at risk for loss of function and prevent loss of function by timely surgical intervention.
Conventional dynamic renal scintigraphy provides information about the function of the affected kidney and supplements the ultrasound findings. The results of diuresis renography are dependent on several physiologic, anatomic, mechanical, and technical factors, including the function of the affected kidney, capacity and compliance of the dilated system, the patient’s hydration status, fullness of the bladder, dose of furosemide, time of injection of furosemide relative to injection of the radiopharmaceutical, and selection of regions of interest for generation of time-activity curves.
