Matsumoto F, Shimada K, Harada Y, Naitoh Y
Department of Urology, Osaka Medical Centre and Research Institute for Maternal and Child Health, Osaka, Japan.
BJU Int. 2003 Dec;92(9):1006-8. doi: 10.1111/j.1464-410x.2003.04508.x.
To evaluate the renal growth pattern in patients with primary vesico-ureteric reflux (VUR) using long-term measurements of split renal function with 99mTc-dimercaptosuccinic acid (DMSA) scintigraphy.
In all, 712 children aged < 16 years (466 boys and 246 girls) with primary VUR were referred to our hospital from July 1991 to December 2000. VUR was diagnosed by voiding cysto-urethrography. The patients were treated either surgically (group 1) or conservatively (group 2) and followed with serial 99mTc-DMSA scintigraphy for up to 10 years. There were 942 examinations in 367 of 712 patients who had repeat scintigraphy. Patients with secondary VUR, VUR to a solitary or fused kidney, or upper urinary tract obstruction, were excluded. Five of 298 patients (1.7%) who had ureteric reimplantation had a febrile urinary tract infection (UTI) soon after surgery but none recurred (recurrence is an indication for surgery in children with VUR); there was no febrile UTI in the 69 patients in group 2. Planar scintigraphy with 99mTc-DMSA was used to assess the absolute uptake (AU) of each kidney, measured as a percentage of the injected dose, and the relative uptake (RU = AU of each kidney/AU of both kidneys) calculated. The initial examination was at least 4 weeks after any febrile UTI in most patients. Serial studies were conducted 1 year after surgery and then biannually in group 1. In group 2 the DMSA scan was repeated every 2-3 years. The change in split renal function was compared with the RU of the right kidney.
The RU of the right kidney at the initial scan correlated closely with those on repeated scans in both groups. The correlation coefficients were 0.99 in group 1 and 0.94-0.97 in group 2 at every study. The change of RU remained within 0.05 in all patients after treatment.
Under strict control of UTI, split renal function in children with primary VUR does not change. There may be no possibility of accelerated or compensatory growth of the kidney with reflux nephropathy, but no concern about deterioration and atrophy either.
采用99m锝-二巯基丁二酸（DMSA）闪烁显像术长期测量分肾功能，以评估原发性膀胱输尿管反流（VUR）患者的肾脏生长模式。
1991年7月至2000年12月，共有712名16岁以下儿童（466名男孩和246名女孩）因原发性VUR转诊至我院。VUR通过排尿性膀胱尿道造影诊断。患者接受手术治疗（第1组）或保守治疗（第2组），并连续进行99mTc-DMSA闪烁显像术随访长达10年。712例患者中有367例进行了重复显像，共942次检查。排除继发性VUR、单侧或融合肾的VUR或上尿路梗阻患者。298例接受输尿管再植术的患者中有5例（1.7%）术后不久发生发热性尿路感染（UTI），但均未复发（复发是VUR患儿手术的指征）；第2组的69例患者中无发热性UTI。采用99mTc-DMSA平面显像评估每个肾脏的绝对摄取量（AU），以注射剂量的百分比表示，并计算相对摄取量（RU = 每个肾脏的AU/双侧肾脏的AU）。大多数患者的初次检查在任何发热性UTI后至少4周进行。第1组术后1年进行系列研究，之后每半年进行一次。第2组每2 - 3年重复进行DMSA扫描。将分肾功能的变化与右肾的RU进行比较。
两组初次扫描时右肾的RU与重复扫描时的RU密切相关。每次研究时，第1组的相关系数为0.99，第2组为0.94 - 0.97。所有患者治疗后RU的变化均在0.05以内。
在严格控制UTI的情况下，原发性VUR患儿的分肾功能不会改变。反流性肾病的肾脏可能不存在加速生长或代偿性生长的情况，但也无需担心其恶化和萎缩。
