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[Renal function evaluation with 99mTc-DMSA renal uptake in primary vesico-ureteral reflux patients].

Evaluation of renal function of 80 patients with primary vesico-ureteral reflux was performed by 99m Tc-DMSA renal scintigraphy. The results were as follows: 1. In 93 kidneys with reflux of 63 patients who did not receive anti-reflux operation, 99mTc-DMSA renal uptake (DMSA uptake) and age-corrected 99mTc-DMSA renal uptake (C-uptake) of grade I VUR did not differ from those of grade II VUR significantly in any age group. DMSA uptake and C-uptake of grade III VUR and grade IV VUR were significantly lower than those of grades I and II. 2. In the age group under 14 years old, almost all of grade I and II VUR showed normal values of DMSA uptake and C-uptake, but in the age group above 15 years old, some of grades I and II showed lower values than normal range. 3. Comparing the images of IVP with those of renal scintigraphy in 125 kidneys of the above mentioned 63 patiensts with reflux (1 patient had unilateral renal aplasia), the kidneys were classified into 3 groups, the 1st group: normal IVP and scintigraphy image, the 2nd group: normal IVP image and damaged scintigraphy image, and the 3rd group: damaged scintigraphy and IVP image. C-uptake was highest in the 1st group, lowest in the 3rd group. Even in the kidneys in which VUR disappeared spontaneously or in the contralateral kidneys of patients with unilateral reflux, renal scintigraphy sometimes showed abnormal images. 4. Comparing the preoperative status with the postoperative status in 54 kidneys with VUR of 34 patients, DMSA uptake of both diseased kidney and bilateral kidneys 2 weeks after operation were significantly higher than preoperative ones. On the other hand, 24-hour endogenous creatinine clearance 2 weeks after operation did not differ from the preoperative value and the values 3 months after operation became higher than preoperative ones. 5. Glomerular function of adult patients with VUR was shown to be lower than child VUR and was not expected to improve even after treatment. 6, Preoperative C-uptake above 50% was thought to be one of the criteria by which the function of kidney with reflux should be expected to improve after operation.