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Background: To find out up to what age there is dispersion in glomerular filtration rate (GFR) values when normalised by body surface area (BSA) and extracellular fluid volume (ECFV), based on the hypothesis that these values differ in childhood age. Methods: A retrospective study was performed on patients aged 0–85 years, with renal pathology, who were administered i.v. 51Cr-EDTA. GFR was obtained using the Ham and Piepsz (children) or Christensen and Groth (adults) formula. Results were normalised by BSA and ECFV. Results: The cut-off point is defined as the age that discriminates between values ± 10 points apart. Using a ROC curve analysis, this age was set at 11.96 years with a sensitivity of 0.83 and a specificity of 0.85. The area obtained was 0.902 (95%CI 0.880–0.923). The results were corroborated by linear regression stratifying by age. For children under 12 years of age, the Pearson correlation was 0.883 (95% CI 0.860–0.902). For those aged 12 years or older, this coefficient was 0.963 (95%CI 0.957–0.968). According to our results, when normalising GFR by BSA and by ECFV there are different behaviours according to age. Conclusion: For children older than 12 years both normalisation methods can be used, but for children younger than 12 years there are differences. We believe that in children under 12 years of age, GFR should be normalised by ECFV. [ABSTRACT FROM AUTHOR]

Glomerular filtration rate (GFR) varies with age, the calculation method, and the correction factor for slope-intercept overestimation. Hence, any normal reference range accompanying the results should be suitably adapted to the method used. For Nuclear Medicine Departments using a two-sample slope-intercept method, the lack of appropriate age-specific normal reference range has been a hindrance to adopting the recently updated Jodal Brochner-Mortensen (JBM) correction over other older and more widely used methods. A retrospective analysis of the routine GFR calculation and clinical reports generated locally from 2006 to 2020 was carried out. GFR was calculated with 99mTc-DTPA plasma clearance using a two-sample slope-intercept method with JBM correction. Age-specific normal range equations were developed from normal healthy subjects. Published normal reference ranges were modified with appropriate correction reversal and compared with the locally developed reference ranges. Age-specific normal GFR reference ranges for 99mTc-DTPA with slope-intercept method and JBM correction were developed and validated with current literature. Normal reference range (Mean ± 2SD) for Normalised GFR (ml min−1 (1.73m2)−1) within 95% confidence limits suitable for use with JBM correction is 100.6 ± 35.2 for children above 2 years and 102.9 – 0.00629 × (Age)2 ± 19.4 for adults. Availability of age-specific normal GFR reference ranges applicable to the target population and appropriately tailored to the calculation method and correction factor enables Nuclear Medicine Departments to update their calculation methods in line with the current literature and also facilitates accurate reporting and evaluation of the calculated GFR results. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the efficacy of GFR measured using ROI from ultrasound technique in diuretic renography for evaluating postoperative outcomes in infants under one year old with congenital hydronephrosis. A retrospective analysis was conducted on thirty infants who underwent abdominal ultrasound and diuretic renography before and after surgery, obtaining preoperative and postoperative gGFRs and uGFRs (measured using ROI from ultrasound technique) determined using the Gates method and ultrasonic-assisted drawing ROI technique, respectively. A comparative study was performed on total GFR as well as individual kidney GFR before and after intervention. The preoperative and postoperative total and single uGFRs were significantly lower than gGFRs, while the postoperative total and single renal function, along with relative renal function in the hydronephrotic kidneys, were also significantly higher than the preoperative results (p < 0.05). Among 30 infants, 23 cases exhibited substantial recovery of renal function in their hydronephrotic kidneys after surgery, 2 cases did not show significant improvement, while 5 cases continued to experience deterioration in renal function. The GFR measured using ROI from ultrasound technique provides a more accurate assessment of renal function changes before and after surgery in infants under one year old with congenital hydronephrosis, facilitating an effective evaluation of postoperative treatment efficacy. [ABSTRACT FROM AUTHOR]

Background/Objectives: We aimed to assess the prevalence and risk factors for acquisition of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (E. coli) in children admitted with urinary tract infection (UTI) at a tertiary university hospital in Saudi Arabia, as well as to investigate antibiotic resistance patterns. Methods: This retrospective cross-sectional study involved hospitalized children aged 0–14 years from January 2018 to December 2022 with urine cultures that grew E. coli or ESBL-producing E. coli. Data of the antimicrobial susceptibility for isolated bacteria were collected. Results: This study analyzed 242 urine samples obtained from 119 children with E. coli UTIs. Of these, 20.7% (n = 50) were ESBL producers. Previous antibiotic use (last 3 months), prophylactic antibiotic use, prior UTI (last 3 months), recurrent UTIs, and underlying co-morbidities (p = 0.011, <0.001, 0.025, <0.001, and 0.013, respectively) had a significant relationship with increased risk of ESBL E. coli UTIs. Generally, the highest resistance rates in the ESBL-producing isolates were for ampicillin and third-generation cephalosporin. Conversely, all ESBL-positive isolates were sensitive to meropenem, with variable resistance rates to other antibiotics as amikacin, nitrofurantoin, quinolones and trimethoprim/sulfamethoxazole (2%, 8%, 56% and 64%, respectively). Conclusions: There is a high prevalence of ESBL production among children hospitalized with E. coli UTIs. Addressing ESBL UTI risk factors helps to recognize high-risk cases and enhance proper antibiotic use. [ABSTRACT FROM AUTHOR]

Background Urinary tract infection (UTI) is one of the commonly encountered conditions in children. Dimercaptosuccinic acid (DMSA) scintigraphy is widely advocated for functional and morphological evaluation of the renal cortex including parenchymal defect. Moreover, only a small percentage of renal defects are detected by ultrasound. We aimed to examine DMSA scintigraphy of children and identify factors associated with cortical defect. Methods Patients aged ≤ 18 years old who underwent DMSA scintigraphy (November 18, 2019–February 2, 2023, 30 children) were included. All children received intravenous injections of 99m Tc-DMSA followed by static planar and single-photon-emission computed tomography imaging at 3 hours. Cortical findings and differential functions of the worst affected kidney were graded accordingly. Grade I has no more than two cortical defects, grade II has more than two cortical defects with normal parenchyma between the defects, while grade III is when generalized damage is noted, and grade IV is when a shrunken kidney is seen with no DMSA uptake. Normal functioning kidney is when the relative function at 45 to 55%, mildly reduced function at 40 to 44%, and substantially impaired function at 10 to 39%, while nonfunctioning is when the differential split renal function < 10%. All data were then statistically analyzed. Results Majority was female (53%). The mean age was 5.85 years. UTI episodes were 73%. Twenty-two children had congenital urinary tract anomalies. All patients with vesicoureteric refluxes (VURs) had positive defects. Scintigraphy showed abnormalities in 17 children affecting unilateral (64%) or both kidneys (36%). There were 17 children (57%) respectively in the abnormal DMSA scan findings category with normal until significant impairment of the functioning kidney category. VURs were significantly associated with abnormal scintigraphy (p < 0.05). A significant association was found between abnormal DMSA scan findings and differential renal function (p < 0.05). Conclusion Significant association was noted between VURs and abnormal DMSA scintigraphy, abnormal DMSA scan findings, and impaired differential renal function. Special consideration should be given to these cases. [ABSTRACT FROM AUTHOR]

99mTc-labeled dimercaptosuccinic acid (99mTc-DMSA) imaging is a well-established and highly sensitive method for the diagnosis of several renal cortical disorders affecting children and adults. Beginning in 2014, 99mTc-DMSA availability was severely impaired when it was added to the Drug Shortages List of the U.S. Food and Drug Administration and was commercially unavailable thereafter. The agent shortage negatively impacted practitioners' ability to evaluate renal cortical defects in children and adults and changed renal imaging practice. A survey among pediatric nuclear medicine clinicians confirmed the clinical need for 99mTc-DMSA. Finally, in early 2023 the Food and Drug Administration again approved 99mTc-DMSA in the United States. During the 99mTc-DMSA shortage, established practitioners may not have had the opportunity of using 99mTc-DMSA as they were accustomed in their experience. Also, newer imaging specialists and referring physicians and technologists may not have benefited from having 99mTc-DMSA in their training. Therefore, it is time to bring back 99mTc-DMSA into the armamentarium of imaging methods available to evaluate regional cortical renal function. [ABSTRACT FROM AUTHOR]

Our study aimed to investigate the association between the characteristics of patients/images and complete remission of renal scarring shown in the first chronic phase Technetium-99m dimercaptosuccinic acid (DMSA) renal scintigraphy images in children with urinary tract infection (UTI). Fifty children, who underwent the chronic phase of DMSA scintigraphy more than twice following UTI diagnosis and had renal scarring in the first chronic phase DMSA renal scintigraphy, were enrolled. They were classified into 2 groups: with and without complete remission of renal scarring on the second chronic phase DMSA renal scintigraphy. Renal scarring was classified into 3 grades based on severity per the image findings. Seven cases had complete remission from renal scarring. There were significant differences in age and severity. Renal scarring might be completely reversed in young children without severe findings on DMSA renal scintigraphy. Additional chronic phase examination may aid in follow-up completion and patients' peace of mind. [ABSTRACT FROM AUTHOR]

Acute kidney injury (AKI) presents significant challenges in pediatric care, often remaining underrecognized. This paper provides an overview of pediatric AKI, highlighting its epidemiology, pathophysiology, diagnosis, predisposing conditions, and treatment. AKI in children stems from diverse causes, including renal tubular damage, vasoconstriction, and inflammation. Diagnosis relies on traditional markers such as serum creatinine and urine output, alongside emerging biomarkers such as Cystatin C, NGAL, KIM-1, IL-18, TIMP-2 and IGFBP7, urinary calprotectin, URBP4, L-FABP, and clusterin. Various pediatric conditions predispose to AKI, including type 1 diabetes, pneumonia, bronchiolitis, appendicitis, gastroenteritis, COVID-19, multisystem inflammatory syndrome, sickle cell disease, and malignancies. Treatment entails supportive care with fluid management and, in severe cases, renal replacement therapy. Timely recognition and management are essential to mitigating adverse outcomes. Enhanced awareness and integration of novel biomarkers could improve pediatric AKI care, warranting further research for better diagnosis and management. [ABSTRACT FROM AUTHOR]

Purpose: To develop a deep learning (DL) model for generating automated regions of interest (ROIs) on 99mTc-diethylenetriamine pentaacetic acid (DTPA) renal scans for glomerular filtration rate (GFR) measurement. Methods: Manually-drawn ROIs retrieved from a Picture Archiving and Communications System were used as ground-truth (GT) labels. A two-dimensional U-Net convolutional neural network architecture with multichannel input was trained to generate DL ROIs. The agreement between GFR values from GT and DL ROIs was evaluated using Lin's concordance correlation coefficient (CCC) and slope coefficients for linear regression analyses. Bias and 95% limits of agreement (LOA) were assessed using Bland-Altman plots. Results: A total of 24,364 scans (12,822 patients) were included. Excellent concordance between GT and DL GFR was found for left (CCC 0.982, 95% confidence interval [CI] 0.981–0.982; slope 1.004, 95% CI 1.003–1.004), right (CCC 0.969, 95% CI 0.968–0.969; slope 0.954, 95% CI 0.953–0.955) and both kidneys (CCC 0.978, 95% CI 0.978–0.979; slope 0.979, 95% CI 0.978–0.979). Bland-Altman analysis revealed minimal bias between GT and DL GFR, with mean differences of − 0.2 (95% LOA − 4.4–4.0), 1.4 (95% LOA − 3.5–6.3) and 1.2 (95% LOA − 6.5–8.8) mL/min/1.73 m² for left, right and both kidneys, respectively. Notably, 19,960 scans (81.9%) showed an absolute difference in GFR of less than 5 mL/min/1.73 m². Conclusion: Our DL model exhibited excellent performance in the generation of ROIs on 99mTc-DTPA renal scans. This automated approach could potentially reduce manual effort and enhance the precision of GFR measurement in clinical practice. [ABSTRACT FROM AUTHOR]

This study aims to investigate the factors effective in predicting the persistence of reflux after the first subureteric transurethral injection (STING) of dextranomer/hyaluronic acid copolymer in pediatric patients with vesicoureteral reflux. The data of patients without a previous history of surgery to treat vesicoureteral reflux and who underwent STING for the first time between September 2011 and November 2020 were investigated retrospectively. After considering exclusion criteria, of 199 patients, 127 patients and 180 renal units were suitable for inclusion. A renal unit-based evaluation was made. Age < 61 months (univariate: p = 0.001, multivariate: p = 0.015, HR: 2.352 (1.181–4.686), OR (95% CI)), moderate reflux level (grade 3) (univariate: p < 0.001, multivariate: p = 0.019, HR: 2.703 (1.177–6.209), OR (95% CI)), DRF (differential renal function) < 45 (univariate: p = 0.020, multivariate: p = 0.047, HR: 1.992 (1.009–3.935), OR (95% CI)), and UDR (ureteral diameter ratio) > 0.15 (univariate: p < 0.001, multivariate: p = 0.005, HR: 2.786 (1.368–5.672), OR (95% CI)) were found predictors of reflux persistence after STING surgery both univariate and multivariate analysis. High reflux level (grade 4–5) was statistically significant in univariate analysis (p < 0.001) but not statistically significant in multivariate analysis (p = 0.215). In our study, UDR and DRF were found to be factors affecting reflux persistence. UDR and DRF should be considered in order to predict reflux resolution in patients who will undergo STING. [ABSTRACT FROM AUTHOR]

Objectives: The configuration of the aortic arch, particularly a Gothic arch shape, in individuals with corrected coarctation of the aorta (CoA) has been associated with a decreased systolic wave amplitude across the arch, which could potentially impair renal perfusion and elevate the risk of arterial hypertension. This study aims to explore the relationship between the morphological characteristics of the aortic arch and their impact on renal perfusion in patients with CoA. Methods: Seventy-one subjects with corrected CoA underwent continuous 24 h ambulatory blood pressure monitoring, computed tomography to assess the aortic arch, and renal perfusion scanning. Subjects were stratified into three groups based on the height-to-width (H/W) ratio of their aortic arch: Group 1 with a H/W ratio of <0.65, Group 2 with a H/W ratio between 0.65 and 0.85, and Group 3 with a H/W ratio of >0.85. Results: Groups 1 and 2 (53,78% and 62.63%) presented with a higher hypertension prevalence of elevated blood pressure than Group 3 (38.89%). Notable variations were observed among the subjects in the time to peak perfusion (Tmax) in the left kidney across the groups. Group 1 showed a median Tmax at 0.27, Group 2 at 0.13, and Group 3 at −0.38 (p-value = 0.079). The differences in Tmax for the right kidney followed a similar trend but were not statistically significant (Group 1 at 0.61, Group 2 at 0.22, and Group 3 at 0.11; p-value = 0.229). Conclusions: This study suggests that variations in the aortic arch morphology might not significantly influence renal perfusion in CoA patients. This indicates the potential adaptability of the renal blood flow, which appears to compensate for reduced perfusion, thus minimizing adverse effects on the kidney function. This adaptability suggests an inherent physiological resilience, emphasizing the need for further targeted research to understand the specific interactions and impacts on treatment strategies for CoA. [ABSTRACT FROM AUTHOR]

Background: Ureteropelvic junction obstruction (UPJO) is characterised by stenosis of the ureteral lumen at the level of the renal pelvis and proximal ureter. At Haukeland University Hospital, robotic-assisted laparoscopic pyeloplasty (RLP) for UPJO has been performed since 2014. The aim of this study was to evaluate the results of the treatment and consider what determines treatment success. Materials and methods: Retrospective review was performed of consecutive patients undergoing RLP between 2014-2022. Outcomes of interest included symptom relief, complication rates and renographic findings at follow-up. Treatment success was defined in terms of symptom improvement and/or improvement as well as relief of obstruction on renography. Results: In total, 95 RLPs were performed in 54 women and 41 men, with a mean age of 40 years (IQR: 21-58). Flank pain was the most frequent presenting complaint (n = 81, 85%) followed by infection (n = 33, 35%). More than one indication for surgery was present in 1/3 of the patients. Urodynamic relevant obstruction on renography was found in 62 patients (65%) preoperatively. Mean operative time was 123 minutes (range 60-270). Two patients experienced minor intraoperative complications. At three months follow-up, 91% of patients had symptom relief, and no obstruction on renography was recorded in 64%. There was no significant association between improvement in symptoms and renography findings at follow-up, p = 1. Conclusions: RLP can deliver a high success rate in terms of symptom relief and few complications. There was no association between renography findings and symptom relief at follow-up. Success after surgery should be determined by symptom relief rather than renography findings. [ABSTRACT FROM AUTHOR]

Background: Augmented renal clearance (ARC) holds a risk of subtherapeutic drug concentrations. Knowledge of patient-, disease-, and therapy-related factors associated with ARC would allow predicting which patients would benefit from intensified dosing regimens. This study aimed to identify ARC predictors and to describe ARC time-course in critically ill children, using iohexol plasma clearance (CLiohexol) to measure glomerular filtration rate (GFR). Methods: This is a retrospective analysis of data from the "IOHEXOL" study which validated GFR estimating formulas (eGFR) against CLiohexol. Critically ill children with normal serum creatinine were included, and CLiohexol was performed as soon as possible after pediatric intensive care unit (PICU) admission (CLiohexol1) and repeated (CLiohexol2) after 48–72 h whenever possible. ARC was defined as CLiohexol exceeding normal GFR for age plus two standard deviations. Results: Eighty-five patients were included; 57% were postoperative patients. Median CLiohexol1 was 122 mL/min/1.73 m2 (IQR 75–152). Forty patients (47%) expressed ARC on CLiohexol1. Major surgery other than cardiac surgery and eGFR were found as independent predictors of ARC. An eGFR cut-off value of 99 mL/min/1.73 m2 and 140 mL/min/1.73 m2 was suggested to identify ARC in children under and above 2 years, respectively. ARC showed a tendency to persist on CLiohexol2. Conclusions: Our findings raise PICU clinician awareness about increased risk for ARC after major surgery and in patients with eGFR above age-specific thresholds. This knowledge enables identification of patients with an ARC risk profile who would potentially benefit from a dose increase at initiation of treatment to avoid underexposure. Trial registration: ClinicalTrials.gov NCT05179564, registered retrospectively on January 5, 2022. [ABSTRACT FROM AUTHOR]

Autosomal dominant polycystic kidney disease (ADPKD) is an inherited disorder characterized by renal tubular cystic dilatations. The cysts can develop anywhere along the nephron, and over time the cystic dilatation leads to kidney enlargement. On the other hand, the cysts begin to reduce the number of functional nephrons as a consequence of cystic expansion that further contributes to the decline in renal function over the years. The pressure exerted by the dilated cysts leads to compensatory mechanisms that further contribute to the decline in renal function. These structural changes are responsible of glomerular hyperfiltration states, albuminuria, proteinuria, and hematuria. However, the presentation of ADPKD varies in children, from a completely asymptomatic child with incidental ultrasound detection of cysts to a rapidly progressive disease. There have been reports of early onset ADPKD in children younger than 2 years that showed a more rapid decline in renal function. ADPKD is caused by a mutation in PKD1 and PKD2 genes. Today, the PKD1 gene mutation seems to account for up to 85% of the cases worldwide, and it is associated with worse renal outcomes. Individuals with PKD2 gene mutation seem to present a milder form of the disease, with a more delayed onset of end-stage kidney disease. The cardinal sign of ADPKD is the presence of renal cysts during renal ultrasound. The current guidelines provide clinicians the recommendations for genetic testing in children with a positive family history. Given that the vast majority of children with ADPKD present with normal or supra-normal kidney function, we explored the glomerular filtration rates dynamics and the renal ultrasound-adjusted percentiles. In total, 14 out of 16 patients had kidney percentiles over 90%. The gene mutations were equally distributed among our cohort. In addition, we compared the modified Schwartz formula to the quadratic equation after adjusting the serum creatinine measurements. It seems that even though children with ADPKD have enlarged kidneys, the renal function is more likely normal or near normal when the quadratic estimation of glomerular filtration rate is used (qGFR tended to be lower, 111.95 ± 12.43 mL/min/1.73 m2 when compared to Schwartz eGFR 126.28 ± 33.07 mL/min/1.73 m2, p = 0.14). Also, when the quadratic equation was employed, not even a single patient reached the glomerular hyperfiltration threshold. The quadratic formula showed that glomerular filtration rates are linear or slightly decreasing after 1 year of follow-up (quadratic ΔeGFR = −0.32 ± 5.78 mL/min/1.73 m2), as opposed to the Schwartz formula that can falsely classify children in a hyperfiltration state (ΔeGFR = 7.51 ± 19.46 mL/min/1.73 m2), p = 0.019. [ABSTRACT FROM AUTHOR]

Vesicoureteral reflux (VUR) is defined as the urine backflow from the urinary bladder to the pyelo-caliceal system. In contrast, intrarenal reflux (IRR) is the backflow of urine from the renal calyces into the tubulointerstitial space. VURs, particularly those associated with IRR can result in reflux nephropathy when accompanied by urinary tract infection (UTI). The prevalence of IRR in patients with diagnosed VUR is 1–11% when using voiding cystourethrography (VCUG), while 11.9–61% when applying the contrast-enhanced voiding urosonography (ceVUS). The presence of IRR diagnosed by VCUG often correlates with parenchymal scars, when diagnosed by a 99mTc dimercaptosuccinic acid scan (DMSA scan), mostly in kidneys with high-grade VURs, and when diagnosed by ceVUS, it correlates with the wide spectrum of parenchymal changes on DMSA scan. The study performed by both ceVUS and DMSA scans showed IRRs associated with non-dilated VURs in 21% of all detected VURs. A significant difference regarding the existence of parenchymal damage was disclosed between the IRR-associated and IRR-non-associated VURs. A higher portion of parenchymal changes existed in the IRR-associated VURs, regardless of the VUR grade. That means that kidneys with IRR-associated VURs represent the high-risk group of VURs, which must be considered in the future classification of VURs. When using ceVUS, 62% of places where IRR was found were still unaffected by parenchymal changes. That was the basis for our recommendation of preventive use of long-term antibiotic prophylaxis until the IRR disappearance, regardless of the VUR grade. We propose a new classification of VURs using the ceVUS method, in which each VUR grade is subdivided based on the presence of an IRR. [ABSTRACT FROM AUTHOR]

Purpose: To determine if children with UPJO demonstrate a clinically significant change in somatic growth following pyeloplasty. Methods: We retrospectively evaluated the growth chart data of infants with SFU grade 3 or 4 congenital hydronephrosis at our institution from 2015 to 2022. Of those, 35 patients underwent pyeloplasty and 66 had no surgical intervention. Patients met criteria if they had SFU 3 or 4 hydronephrosis and MAG3 renal scan. If patients underwent surgery, height and weight percentiles were recorded from the pre-op and 6–16-month follow-up visits. In non-surgery patients, measurements were taken near the median age of surgery in the intervention group and 6–16 months later. Interval changes in group height and weight percentiles are compared for significant changes. Results: The surgery and non-surgery groups did not differ in terms of gender (71% vs 74% Male), starting age (296 vs 244 days), starting weight (58th vs 52nd percentile), or time between measurements (255 vs 260 days), though the surgery group had significantly less height in the pre-operative period (43rd vs 55th percentile, p = 0.050) and were more likely to have delayed drainage on renal scan (83% w/delay vs 35%). The surgery group showed a significant increase in height (18.9 percentiles; 95% CI 11–27) and weight (6.0 percentiles; 95% CI 0.50–12) after intervention. Conclusions: Patients with congenital hydronephrosis due to UPJO that underwent pyeloplasty showed a significant increase in weight and height at 6–16 months postoperatively compared to those that were managed with close observation. This suggests UPJO might lead to growth delay in infants. [ABSTRACT FROM AUTHOR]

(1) Background: PSMA ligand PET/CT is increasingly important for diagnostics of prostate cancer and other tumor diseases. In particular, the radiopharmaceutical [68Ga]Ga-PSMA-11 is widely used. Besides its tumor-specific binding, the uptake within the kidneys is dominant and seems to visualize the renal cortex specifically. Kidney diseases may alter the uptake of radiopharmaceuticals. Therefore, the correlation between renal uptake in PET/CT imaging and renal function should be investigated. (2) Methods: A group of 103 male patients were retrospectively evaluated for eGFR according to the CKD-EPI equation, tracer uptake intensity (SUVmax, SUVpeak, SUVmean), the molecular volume of the renal cortex, morphological kidney size, and total renal uptake. Manual and three different computer-assisted contouring methods (thresholds at 50% of SUVmax, 30% of SUVmax, and absolute SUV of 20) were used for measurements. Correlations between parameters were calculated using linear regression models. (3) Results: Renal SUVmax, SUVpeak, and SUVmean do not correlate with eGFR for manual or computer-assisted measurements. In contrast, molecular cortex volume shows a moderate correlation with eGFR (R2 = 0.231, p < 0.001), superior to morphological kidney size. A contouring threshold of 30% of SUVmax outperformed the other settings for renal cortex volume and total renal uptake. (4) Conclusions: Renal uptake of [68Ga]Ga-PSMA-11 cannot predict eGFR, but the functional renal cortex can be quantified by PET/CT imaging. [ABSTRACT FROM AUTHOR]

Objective: To describe and analyze the clinical manifestation and pre-DRF of UPJO children with polyps and explore the possible influencing factors of supranormal pre-DRF. Patients and methods: All patients undergoing primary Anderson-Hynes pyeloplasty for UPJO due to polyp were retrospectively reviewed. Patients' characteristics, parameters of ultrasound and dynamic renograms (DR) were recorded in elaborate. Pre-DRF in groups of different age, weight, gender, pain, grade of hydronephrosis, anterio-posterior pelvic diameter (APD), length of kidney and postoperative ultrasonic parameters were compared. Results: A total of 18 UPJO children with polyps were included. Five (27.78%) patients had SFU III grade of hydronephrosis. Seven (38.89%) patients were supranormal pre-DRF. All patients had pre-DRF > 40%. Drainage curve was delayed excretion in 12 (66.67%) patients and T1/2 < 20 min was in 4 (22.22%) patients. Among the 16 patients who underwent preoperative IVP examination, 15 (93.75%) patients had concentration of intrarenal pelvis contrast agent within 10 min. No significant difference in post-APD reduction rate and post-minPT increased was found between supranormal pre-DRF and non-supranormal pre-DRF groups. The supranormal pre-DRF was more likely to occur in young and low-weight children. Conclusion: The preoperative renal function of UPJO patients with polyps was well preserved, and 38.89% of them had supranormal pre-DRF. Patients with supranormal pre-DRF can be managed with the same strategies as those with normal renal function. [ABSTRACT FROM AUTHOR]

Background: The management of UPJO with poor function kidney, less than 10%, has been the subject of debate for more than a decade. Some authors have recommended nephrectomy, while others favor renal salvage (pyeloplasty). We report our experience with laparoscopic assisted pyeloplasty in pediatric patients with poorly functioning kidneys in comparison with an open approach. Materials and methods: A retrospective study was conducted to review 65 patients who were diagnosed with hydronephrosis and had impaired renal function due to UPJO. The study was conducted in the pediatric surgery departments of Al-Azhar University Hospital and Fattouma Bourguiba University Hospital of Monastir over a period of 20 years. Limited to pediatric patients with UPJO with ≥ Grade III hydronephrosis, antero-posterior pelvic diameter ≥ 20 mm, as well as a renal function equal to or less than 10%, was corrected by laparoscopic assisted or open pyeloplasty. Results: There were 40 cases in group A who underwent laparoscopic assisted pyeloplasty, and 25 cases in group B who underwent open pyeloplasty. There were no complications or difficulties during the operation. The mean operative time in group A was 90 ± 12 min, while in group B, it was 120 ± 11 min. The renal assessment parameters significantly improved in both groups. In group A, the mean split renal function was 7.9 ± 1.3% and increased to 22.2 ± 6.3%. In group B, the mean split renal function was 8.1 ± 1.1% and increased to 24.2 ± 5.1%. However, the differences between both groups in terms of pre-operative and post-operative renal functions were statistically insignificant. Conclusion: Laparoscopic assisted pyeloplasty is an effective treatment for patients with poorly functioning kidneys, especially those with less than 10% function. While this surgical procedure requires shorter operative times, it yields functional outcomes that are comparable to open approach. [ABSTRACT FROM AUTHOR]

Objective: We aimed to identify clinical and radiological predictors of the need for surgical intervention in infants with antenatally detected UPJO. Material and methods: We prospectively followed infants born with antenatally diagnosed ureteropelvic junction obstruction (UPJO) presented at our outpatient clinics for evidence of obstructive injury with a standard protocol with ultrasonography and renal scintigraphy. Indications for surgery included progression of hydronephrosis on serial examinations, initial differential renal function (DFR) ⩽35% or >5% loss in sequential studies, and febrile urinary tract infection (UTI). Univariate and multivariate analyses were utilized to define the predictors for surgical intervention, while the appropriate cut-off value of the initial Anteroposterior diameter (APD) was determined using the receiver operator curve analysis. Results: Univariate analysis revealed a significant association between surgery, the initial APD, cortical thickness, Society for Fetal Urology grade, UTD risk group, initial DRF, and febrile UTI (p -value < 0.05). No significant association between surgery and sex or side of the affected kidney (p -value 0.91 and 0.38, respectively). On multivariate analysis, the initial APD, initial DRF, obstructed renographic curve, and febrile UTI (p -value < 0.05) were the only independent predictors for surgical intervention. An initial APD of 23 mm can predict surgical requirement, with a specificity of 95% and sensitivity of 70%. Conclusion: For antenatally diagnosed UPJO, the APD value (at the age of 1 week), DFR value (at the age of 6–8 weeks), and febrile UTI during follow-up are significant and independent predictors of the need for surgical intervention. APD, when used with a cut-off value of 23 mm, is associated with high specificity and sensitivity for predicting surgical need. [ABSTRACT FROM AUTHOR]

Purpose: Recurrent urinary tract infections (UTIs) in children is a major challenge for pediatricians. This study was designed to investigate the risk factors for recurrent UTIs and determine the association between recurrent UTIs and clinical findings, including growth patterns in infants and children younger than 24 months of age. Methods: We retrospectively reviewed the medical records of 147 patients <24 months of age with UTIs who were hospitalized between August 2018 and October 2021. The patients were divided into recurrent and single UTI episode groups. Clinical findings and anthropometric and laboratory data were compared between the two groups. Results: In the recurrent UTI group, the weight-for-length (WFL) percentile at the first UTI diagnosis was lower compared to the single UTI episode group, and the weight-for-age percentile at 3-month and 6-month follow-ups after the first UTI decreased (all P<0.05). In univariable logistic regression analysis, higher birth weight, lower WFL percentile, the presence of hydronephrosis, acute pyelonephritis or vesicoureteral reflux, the use of prophylactic antibiotics, and non-Escherichia coli infections were associated with the development of recurrent UTIs (all P<0.05). However, in the multivariable analysis, only the presence of hydronephrosis and prophylactic antibiotic use were independently related to UTI recurrence (P<0.05). Conclusions: The presence of hydronephrosis at the first UTI can be helpful for predicting UTI recurrence in young children aged <24 months. Antibiotic prophylaxis may be associated with UTI recurrence. Potential growth delay should be carefully monitored in infants with recurrent UTI. [ABSTRACT FROM AUTHOR]

Background: Bisphenol A diglycidyl ether (BADGE) and Bisphenol F diglycidyl ether (BFDGE) are used in medical devices, such as intravenous sets, syringes, and catheters. Several studies have reported that these compounds are endocrine disruptors, cytotoxic, and genotoxic, raising concerns about their adverse effects on infants, in a stage of remarkable growth and development. The present study aimed to measure the serum concentrations of BADGE, derivatives of BADGE, and BFDGE in infants and examine the factors that influence them. Methods: Ten infants admitted to the neonatal intensive care unit (NICU) were enrolled in the present study. Blood samples from each infant and questionnaires from their mothers were collected twice, at 1–2 months and 7 months of age. BADGE, BADGE·H2O, BADGE·2H2O, and BFDGE were quantified using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Results: Serum BADGE·2H2O was identified in all infants, at both 1–2 months (2.30–157.58 ng/ml) and 7 months of age (0.86–122.85 ng/ml). One of the two infants who received invasive ventilation showed a substantially increased BADGE·2H2O concentration. There was no significant difference in BADGE·2H2O concentrations at 7 months of age between the group that ate commercial baby food at least ≥ 1 time per week and the group that did not. Conclusions: BADGE·2H2O was detected in the serum of all infants with a history of NICU hospitalization. Future studies are needed to determine the source of BADGE exposure and investigate its effects on infant development. [ABSTRACT FROM AUTHOR]

Introduction: The most common interventions in lower urinary tract obstruction are vesico-amniotic shunting (VAS) and serial amnioinfusions; however, their outcome remains uncertain. The aim of the study was to assess the kidney function as well as clinical complications in boys at the age of 6 months with posterior urethral valves (PUV), who underwent prenatal VAS and survived the neonatal period. Material and methods: The study group consisted of 14 boys and the mean time of the VAS procedure was 22 weeks of gestational age (GA). Children were born in 34 GA (29--39) with average birth weight of 2860 g. Four fetuses needed amnioinfusion. In the study we assessed physical development, prevalence and aetiology of urinary tract infections (UTIs), number of hospitalizations, estimated glomerular filtration rate, presence of hypertension, albuminuria, proteinuria and acidosis. Results: Average body weight at 6 months of life was 7.2 kg. 86% of children had at least one UTI; the same percentage were given antibacterial prophylaxis. 36% underwent urinary diversion. Median number of hospitalizations was 4. One patient required chronic renal replacement therapy, and one needed a short course of peritoneal dialysis. Median serum creatinine level was 0.65 mg/dl with estimated glomerular filtration rate (eGFR) 50.6 ml/min/1.73 m². Average serum cystatin C level was 1.50 mg/l with eGFR 48.5 ml/min/1.73 m². 43% developed acidosis. 71% had elevated albuminuria with a median urine albumin-to-creatinine ratio of 581.64 mg/g. 28.5% had overt proteinuria. Conclusions: Growth at the age of 6 month of infants with PUV after prenatal VAS was barely satisfactory. More than half had impaired kidney function, but the need for renal replacement therapy was uncommon. [ABSTRACT FROM AUTHOR]

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Another important point we wish to highlight is that the authors have compared the pre-operative CTT values of normal contralateral kidney to that of affected PUJO kidney to construct the ROC curve. Management dilemma in pelvi-ureteric junction obstruction: is cortical transit time the answer? While most of the articles say 3 min as cutoff for normal CTT [[2]], the authors [[1]] found 50% of post-pyeloplasty patients having a delayed CTT even with 4.25 min cutoff proposed by them. [Extracted from the article]

Purpose: Pelvi-ureteric junction obstruction (PUJO) is the leading cause for hydronephrosis in children. Diuretic renography used in the pre- and post-operative evaluation of pyeloplasty may not be reliable in predicting the outcome. Methods: A prospective study was conducted from October 2018 to November 2020, including all children with unilateral PUJO undergoing Pyeloplasty. Renal diuretic renography scans done in the pre and post operative periods were assessed for transit time. The time taken for the isotope to reach the renal pelvis was noted by a single observer as the transit time, from the dynamic frames of the diuretic renogram. Results: Of the 65 children, 74% were boys. The transit time (median) in the preoperative renography was 10 min, whereas the same was 4 min 45 s in the postoperative period, the decrease was statistically significant. On evaluation of transit time with ROC (receiver operating characteristics) curve, a cut-off of 4 min and 25 s was arrived at, which could identify the delayed drainage reliably. Conclusion: Improvement in transit time is a reliable predictor of renal function improvement after pyeloplasty, comparing favorably in relation to split renal function. [ABSTRACT FROM AUTHOR]

Background: Scintigraphy using technetium-99m labelled dimercaptosuccinic acid ([99mTc]Tc-DMSA), taken up in the proximal tubules, is the standard in functional imaging of the renal cortex. Recent guidelines recommend performing [99mTc]Tc-DMSA scintigraphy with single photon emission computed tomography (SPECT). Prostate-specific membrane antigen (PSMA) targeted positron emission tomography (PET) is used for staging and localization of recurrence in prostate cancer. A high renal uptake is often seen on PSMA PET, concordant with known PSMA expression in proximal tubules. This suggests PSMA PET could be used analogous to [99mTc]Tc-DMSA scintigraphy for renal cortical imaging. [18F]PSMA-1007 is a promising radiopharmaceutical for this purpose due to low urinary clearance. In this study, we aimed to compare [18F]PSMA-1007 PET to [99mTc]Tc-DMSA SPECT regarding split renal uptake and presence of renal uptake defects, in patients with prostate cancer. Three readers interpreted PET and SPECT images regarding presence of renal uptake defects, with each kidney split into cranial, mid and caudal segments. Kidneys were segmented in PET and SPECT images, and left renal uptake as a percentage of total renal uptake was measured. Results: Twenty patients with prostate cancer were included. 2 participants had single kidneys; thus 38 kidneys were evaluated. A total of 29 defects were found on both [99mTc]Tc-DMSA SPECT and [18F]PSMA-1007 PET. Cohen's kappa for concordance regarding presence of any defect was 0.76 on a per-segment basis and 0.67 on a per-kidney basis. Spearman's r for left renal uptake percentage between [99mTc]Tc-DMSA SPECT and [18F]PSMA-1007 PET was 0.95. Conclusions: [18F]PSMA-1007 PET is comparable to [99mTc]Tc-DMSA SPECT for detection of uptake defects in this setting. Measurements of split renal function made using [18F]PSMA-1007 PET are valid and strongly correlated to measurements made with [99mTc]Tc-DMSA SPECT. [ABSTRACT FROM AUTHOR]

Purpose: The manuscript aims to characterize the principles of best practice in performing nuclear medicine procedures in paediatric patients. The paper describes all necessary technical skills that should be developed by the healthcare professionals to ensure the best possible care in paediatric patients, as it is particularly challenging due to psychological and physical conditions of children. Methods: We performed a comprehensive literature review to establish the most relevant elements of nuclear medicine studies in paediatric patients. We focused the attention to the technical aspects of the study, such as patient preparation, imaging protocols, and immobilization techniques, that adhere to best practice principles. Furthermore, we considered the psychological elements of working with children, including comforting and distraction strategies. Results: The extensive literature review combined with practical conclusions and recommendations presented and explained by the authors summarizes the most important principles of the care for paediatric patient in the nuclear medicine field. Conclusion: Nuclear medicine applied to the paediatric patient is a very special and challenging area, requiring proper education and experience in order to be performed at the highest level and with the maximum safety for the child. [ABSTRACT FROM AUTHOR]

Developmental language disorder (DLD) is a heterogenous neurodevelopmental disorder that affects a child's ability to comprehend and/or produce spoken and/or written language, yet it cannot be attributed to hearing loss or overt neurological damage. It is widely believed that some combination of genetic, biological, and environmental factors influences brain and language development in this population, but it has been difficult to bridge theoretical accounts of DLD with neuroimaging findings, due to heterogeneity in language impairment profiles across individuals and inconsistent neuroimaging findings. Therefore, the purpose of this overview is two-fold: (1) to summarize the neuroimaging literature (while drawing on findings from other language-impaired populations, where appropriate); and (2) to briefly review the theoretical accounts of language impairment patterns in DLD, with the goal of bridging the disparate findings. As will be demonstrated with this overview, the current state of the field suggests that children with DLD have atypical brain volume, laterality, and activation/connectivity patterns in key language regions that likely contribute to language difficulties. However, the precise nature of these differences and the underlying neural mechanisms contributing to them remain an open area of investigation. [ABSTRACT FROM AUTHOR]

Background: Urinary tract infection (UTI) is considered one of the most common types of infection in children. Vesicoureteral reflux (VUR) is one of the major risk factors of UTI leading to renal scarring. Currently, two diagnostic methods are used for the evaluation of VUR, including voiding cystourethrography (VCUG) and radionuclide cystourethrography (DRNC). The present study examines the prevalence and intensity of VUR using direct radionuclide cystography (DRNC) in children referred to the Nuclear Medicine Division of Imam Reza Hospital in Tabriz, Iran. Materials and Methods: The referred patients were studied by DRNC in filling, post filling, voiding and post voiding phases if there was confirmed VUR or not. Furthermore, VCUG, sonography and urine culture had been performed for all the patients prior to our investigation. Both dynamic and static imaging were performed from the bladder, ureters and kidneys. The results were studied by a nuclear medicine physician to assess VUR and grade it. Results: The prevalence of VUR among all 300 patients was calculated to be 29.3%. Most of the cases of VUR were unilateral (63.6%), among which involvement of the left kidney (42%) was significantly more frequent (p=0.022). The most common grade in the cases with unilateral involvement was grade B, and in those with bilateral involvement, grade C. The highest frequency of VUR was observed in the age group below 1 year (10%, n=30), followed by 1-4 years and 5-8 years, each with the frequency of 8.67% (n=26). There was no significant difference in terms of frequency of VUR based on age (p=0.198). Conclusion: Our study showed that there is no significant association between VUR and urine culture results, but there is significant association between sonography/clinical findings and VUR. Moreover, the results demonstrated that DRNC is more sensitive than VCUG in the detection of VUR. [ABSTRACT FROM AUTHOR]