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Original Article

Pak J Nucl Med. 2016; 6(1): 19-24


Assessment of renal parenchymal damage by DMSA after PCNL procedure in children using adult-sized equipment

Mohammad Sohaib, Manoj U Shenoy, Michael J Kellett, Patrick G Duffy, Isky Gordon.




Abstract

Aims: Percutaneous nephrolithotomy (PCNL) is an established technique for the management of renal calculi. The recent advances in this procedure in children include miniaturizing the endoscopic instruments used for renal access. However, there is limited data on the functional effects of PCNL on the renal parenchyma, performed using adult-sized equipment in the paediatric population. This study was therefore aimed to determine the effects of PCNL on the renal parenchyma in children with renal calculi using technetium-99m labelled dimercaptosuccininc acid (99mTc-DMSA)scans. Methods: Pre and post-surgery DMSA scans of 26 paediatric patients who had undergone PCNL over a five-year period were reviewed. The ages of the patients ranged from 1 year to 12.5 years (median: 3.75 years) at the time of PCNL. The procedures were done with 18 Fr or higher sized Amplatz sheath. DMSA scans was performed from 1 day to 47 months before the PCNL and 2 months to 27 months after the procedure and interpreted by two independent observers. Regions-of-interest around each kidney were drawn to determine differential renal function (DRF) of the kidneys. Results: Twenty patients (77 %) showed no change or showed improvement in postprocedure scans. Mean ± SD DRF was 44.1 ± 9.7% before and 44.6 ± 10.6% after the procedure (p=0.52, n=21). Conclusion: We conclude that the PCNL procedure in children undertaken with adultsized equipment may show renal defects in nearly one-fourth of children but there is no significant change in their global renal function.






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