Značaj diurezne 99mTc DTPA scintigrafije u proceni renalne funkcije i drenaže kod dece sa prenatalno otkrivenom hidronefrozom
Sažetak
Uvod/Cilj. Još uvek postoje kontroverze o načinu postnatalnog praćenja dece sa prenatalno dijagnostikovanom hidronefrozom. U ovom radu prikazali smo rezultate diurezne 99mTc diethylenetriamine pentaacetic acid (DTPA) scintigrafije bubrega kod 30-oro dece sa antenatalnom dijagnozom dilatacije bubrežne karlice. Cilj ove studije bio je procena renalne funkcije na osnovu stepena pražnjenja bubrega nakon diuretske stimulacije i separatnog klirensa, kao i korelacija ovih nalaza sa anterioroposteriornim prečnikom (anterioposterior pelvic diameter – APD) bubrežne karlice dobijenog ultrazvukom. Metode. Diurezna DTPA scintigrafija bubrega (F+15 protokol) urađena je kod 30-oro dece (25 dečaka i 5 devojčica, uzrasta 2–24 meseca, medijana 6 meseci) sa 60 renalnih jedinica (RU) kod kojih je perinatalno ultrazvučno utvrđena hidronefroza lakog do teškog stepena. Medijana APD iznosila je 15 mm (5–30 mm). Postnatalno udružene kliničke dijagnoze bile su opstrukcija pelviureteričnog spoja (PUJ) kod 11, hidronefroza kod 10, megaureter kod 6, vezikoureteralni refluks (VUR) kod 2 i zadnja valvula uretre kod jednog deteta. Na osnovu scintigrama i vrednosti Tmax/2 nakon diuretske stimulacije na renografskim krivuljama renalna drenaža je klasifikovana kao dobra, parcijalna i loša ili odsutna. Separatni klirens je računat metodom integrala. Rezultati. Dobra renalna drenaža dobijena je kod 36/60 RU, parcijalna kod 13/60 RU i loša ili odsutna kod 11/60 RU. Separatni klirens > 40% dobijen je kod 55/60 RU, dok ni kod jedne RU separatni klirens nije bio manji od 23,5%. Opstrukcija se nije mogla isključiti kod 94,1% dece sa teškom hidronefrozom. Zaključak. Diurezna scintigrafija bubrega preporučuje se kao korisna metoda u postnatalnom praćenju i terapijskom odlučivanju kod dece sa prenatalno dijagnostikovanom hidronefrozom, posebno u izdvajanju neopstruktivne hidronefroze od opstruktivne. Takođe, važna je procena i praćenje vrednosti separatnog klirensa. Naši rezultati ukazuju da čak i kod parcijalne ili odsutne renalne drenaže, separatni klirens ne mora biti značajno smanjen.
Ključne reči:
novorođenče; hidronefroza dijagnostika, prenatalna; renografija, radioizotopska.
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