PURPOSE: An inter-observer variability exists in the measurement of the renal length during ultrasonography, but dimercaptosuccinic acid (DMSA) scintigraphy allows greater objectivity. Thus, the aim of this study was to evaluate the discrepancy of the renal length measured using the two methods. MATERIALS AND METHODS: Between January 2003 and June 2005, 249 consecutive patients underwent DMSA scintigraphy and ultrasonography. Due to the exclusion of kidneys where a photon defect was observed during DMSA scintigraphy, the number of kidney enrolled in this study was 439. The renal length measurements in any plane were longest using ultrasonography. The renal lengths were measured using DMSA scintigraphy by assessing the maximum pixel length, which was then converted to centimeters. RESULTS: The mean renal lengths measured by DMSA scitigraphy and ultrasonography were 8.06+/-1.49 and 6.80+/-1.38cm, respectively. The mean difference in the renal length measured between the two methods was 1.26+/-0.84cm. The sonographic renal length was significantly shorter than that found via scintigraphy (Student's t-test, p<0.001). CONCLUSION: Our results were similar to those of previously reported studies, where the scintigraphic renal length exceeded that obtained sonographically. Due to the possibility of underestimating the renal length when using ultrasonography, clinicians must be cautious when following up pediatric patients using ultrasonography.
Humans ; Kidney ; Observer Variation ; Radionuclide Imaging* ; Succimer* ; Technetium Tc 99m Dimercaptosuccinic Acid ; Ultrasonography*

PURPOSE: To evaluate the prevalence of abnormalities seen on sonography and renal scintigraphy, according tothe grade of vesicoureteral reflux (VUR) on in voiding cystourethrography (VCUG). MATERIALS AND METHODS: Onehundred and forty-nine patients (age range : 1 months - 10 years) with urinary tract infection underwentsonography, VCUG, and renal scans, and 32 showed VUR on VCUG. We retrospectively evaluated the frequency andcharacteristic findings of sonographic abnormalities according to the grade of VUR, and also the frequency ofcortical defects seen on renal scans of 32 patients with VUR. The remaining 117 patients without VUR were alsoevaluated for the frequency of abnormal findings seen on sonography and renal scans. RESULTS: Among 32 patients(49 kidneys) with VUR, abnormal findings were not detected in 17 (29 kidneys) on sonography ; thus, findings wereabnormal in 15(20 kidneys, 41%). Among these 20 kidneys, renal calyceal and/or pelvic dilatation and dilatation ofdistal ureter were seen in 11, all of which were grade 4-5 VUR. Renal pelvic dilatation only was noted in eightkidneys ; two were grade 1-3 and six were grade 4-5 VUR. Nineteen patients (24 kidneys, 49%) showed focal corticaldefects on renal scintigraphy. Six kidneys were grade 1-3, and 18 kidneys were grade 4-5 VUR. Of 117 patientswithout VUR, 34 patients (29%) showed renal pelvic dilatation on sonography and in 14 patients (12%), corticaldefects were seen on renal scintigraphy. CONCLUSION: Among 32 patients with VUR, 41% showed abnormal sonographicfindings and in 49%, cortical defects were seen on renal scintigraphy. With a higher grade of VUR, the prevalenceof abnormalities increased on both sonography and renal scintigraphy. Sonographic demonstration of renal calicealand/or pelvic dilatation associated with ipsilateral distal ureteric dilatation was the characteristic finding inhigh grade VUR.
Dilatation ; Humans ; Kidney ; Prevalence ; Radionuclide Imaging* ; Retrospective Studies ; Ultrasonography* ; Ureter ; Urinary Tract Infections ; Vesico-Ureteral Reflux*

The common causes of rhabdomyolysis include trauma, hypoxia, drugs, toxins, infections and hyperthermia. Operative insults, including direct trauma and ischemia, have the potential to cause the development of rhabdomyolysis. Pneumatic tourniquets used during arthroscopic knee surgery to prevent blood loss have led to many complications such as nerve paralysis and vascular injuries. Rhabdomyolysis can also be caused by prolonged pneumatic tourniquet application without a midapplication release, and also from an increased application pressure, but the actual incidence of this is low. In order to prevent rhabdomyolysis, the clinicians must be aware of such risks and follow strict guidelines for the application time, the midapplication release and also the inflation pressure. Vigorous hydration and postoperative patient surveillance are helpful to prevent rhabdomyolysis. We have recently experienced a case of rhabdomyolysis after the arthroscopic knee surgery, and the rhabdomyolysis could have been associated with the use of a pneumatic tourniquet.
Adult ; Anterior Cruciate Ligament/injuries/surgery ; *Arthroscopy/statistics & numerical data ; Humans ; Kidney Failure/etiology/radionuclide imaging/ultrasonography ; Knee Joint/*surgery ; Male ; Postoperative Complications/etiology/radionuclide imaging/ultrasonography ; Rhabdomyolysis/*etiology/radionuclide imaging/ultrasonography ; Tourniquets/*adverse effects

PURPOSE: Multicystic dysplastic kidney(MCDK) is characterized by the presence of multiple cysts of varying sizes. It is associated with ureteral or pelviureteral atresia, and a non-functioning kidney. The purpose of this study was to examine the clinical feature and the natural history of MCDK. METHODS: A study was performed in 36 children with prenatal diagnosis of MCDK from 1989 to 1999. All patients underwent renal ultrasonography and scintigraphy, and most underwent voidin, cystourethrography after birth. Follow-up renal ultrasonography was performed generally every year. RESULTS: Initial size of ultrasonography showed that MCDK was larger than normal in 27 cases, normal in 5 cases, and smaller than normal in 4 cases. Follow-up was available on 26 children during 12-78 months. In one patient, there was a complete involution of the MCDK. In 15 patients(58%), there was a reduction in size and 9 patients(35N) showed no change. One patient underwent nephrectomy for an enlarged MCDK. Voiding cystourethrography in 23 patients revealed vesicoureteral reflux in 6(26%). Other abnormalities of the contralateral kidney was detected in 3 of 36 children(8%), consisting of hydronephrosis, hydronephrosis and ureterocele, and simple cyst. Hypertrophy of the contralateral kidney was observed in 14% at birth and 50% in follow up. No renal dysfunction, hypertension and urinary tract infection were noted in all patients during follow up. CONCLUSION: The natural history of MCDK demonstrates a low incidence of complications and a high incidence of spontaneous regression. Therefore, uncomplicated MCDK is best managed conservatively. But further long-term follow up study is needed.
Child ; Follow-Up Studies ; Humans ; Hydronephrosis ; Hypertension ; Hypertrophy ; Incidence ; Kidney ; Multicystic Dysplastic Kidney* ; Natural History* ; Nephrectomy ; Parturition ; Prenatal Diagnosis ; Radionuclide Imaging ; Ultrasonography ; Ultrasonography, Prenatal* ; Ureter ; Ureterocele ; Urinary Tract Infections ; Vesico-Ureteral Reflux

PURPOSE : Urinary tract infections (UTIs) of children require prompt and correct diagnosis and treatment to reduce the risk of renal damage. As a first step to improve the outcome of UTI in Korea, we investigated the practical variations in the methods of diagnosis, treatment, and evaluation of children with UTI and UTI prevention. METHOD : A questionnaire related to the individual policy on UTI diagnosis, treatment, imaging test, and prevention was submitted to 26 experts. RESULT : Majority of the experts used bag-collected urine specimen for infants and mid-stream urine specimen for children for urinary culture. With a negative result of culture study, they diagnosed UTI when there was pyuria, positive results of the nitrite test, or bacteriuria. 80 % of experts prescribed prophylactic antibiotics after upper tract UTI. Operative treatment of vesicoureteral reflux (VUR) was indicated for children older than one or two years old with high-grade VUR, refractory breakthrough infections, or recurrent UTIs. Most of them performed kidney ultrasonography on the diagnosis of UTI and more than half of them evaluated children treated of UTI with vesicocystourethrogram and/or DMSA scintigraphy. Majority did not recommend circumcision. Half of the experts were screening siblings of VUR patients. CONCLUSION : Considering the variations exposed through this study, systematic guidelines for management of children with UTI in Korea would be necessary.
Anti-Bacterial Agents ; Bacteriuria ; Child* ; Circumcision, Male ; Diagnosis ; Female ; Humans ; Infant ; Kidney ; Korea* ; Male ; Mass Screening ; Pyuria ; Surveys and Questionnaires ; Radionuclide Imaging ; Siblings ; Succimer ; Ultrasonography ; Urinary Tract Infections* ; Urinary Tract* ; Vesico-Ureteral Reflux

No abstract available.
Adolescent ; Biopsy, Fine-Needle ; Fluorodeoxyglucose F18/diagnostic use ; Glomerulosclerosis, Focal Segmental/therapy ; Graft Rejection/drug therapy ; Humans ; Immunosuppressive Agents/therapeutic use ; *Kidney Transplantation ; Liver/radiography/ultrasonography ; Lymphoproliferative Disorders/pathology/*radiography/radionuclide imaging ; Male ; Positron-Emission Tomography ; Tomography, X-Ray Computed

No abstract available.
Anticoagulants/therapeutic use ; Antithyroid Agents/therapeutic use ; Graves Disease/*complications/diagnosis/drug therapy ; Humans ; Infarction/diagnosis/drug therapy/*etiology ; Kidney/*blood supply/radiography ; Male ; Middle Aged ; *Thyroid Gland/radionuclide imaging/ultrasonography ; Thyrotoxicosis/diagnosis/drug therapy/*etiology ; Tomography, X-Ray Computed ; Treatment Outcome

PURPOSE: This study was conducted to determine the predictive value of clinical, laboratory, and imaging variables for the diagnosis of vesicoureteral reflux in children with their first febrile urinary tract infection. MATERIALS AND METHODS: One hundred fifty-three children with their first febrile urinary tract infection were divided into two groups according to the results of voiding cystourethrography: 60 children with vesicoureteral reflux and 93 children without. The sensitivity, specificity, positive and negative predictive value, likelihood ratio (positive and negative), and accuracy of the clinical, laboratory, and imaging variables for the diagnosis of vesicoureteral reflux were determined. RESULTS: Of the 153 children with febrile urinary tract infection, 60 patients (39.2%) had vesicoureteral reflux. There were significant differences between the two groups regarding fever>38degrees C, suprapubic pain, C-reactive protein quantitative level, number of red blood cells in the urine, and results of renal ultrasound and dimercaptosuccinic acid renal scanning (p<0.05). There were significant positive correlations between fever>38.2degrees C and dimercaptosuccinic acid renal scanning and vesicoureteral reflux. Also, there were significant positive correlations between the erythrocyte sedimentation rate, positive urinary nitrite test, hyaline cast, and renal ultrasound and high-grade vesicoureteral reflux. CONCLUSIONS: This study revealed fever>38.2degrees C and dimercaptosuccinic acid renal scanning as the best predictive markers for vesicoureteral reflux in children with their first febrile urinary tract infection. In addition, erythrocyte sedimentation rate, positive urinary nitrite test, hyaline cast, and renal ultrasound are the best predictive markers for high-grade vesicoureteral reflux.
Biological Markers/metabolism ; Blood Sedimentation ; C-Reactive Protein/metabolism ; Child ; Child, Preschool ; Cross-Sectional Studies ; Female ; Fever/etiology ; Humans ; Infant ; Kidney/radionuclide imaging/ultrasonography ; Male ; Predictive Value of Tests ; Radiopharmaceuticals/diagnostic use ; Sensitivity and Specificity ; Technetium Tc 99m Dimercaptosuccinic Acid/diagnostic use ; Urinary Tract Infections/*etiology ; Vesico-Ureteral Reflux/*complications/*diagnosis