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Byline: Khalid Ismaili (1,2,8), Fred E. Avni (3), Amy Piepsz (4), Karl M. Wissing (5), Pierre Cochat (6), Didier Aubert (7), Michelle Hall (1,2) Keywords: Prenatal diagnosis; Fetal hydronephrosis; Urinary tract pathology; Ultrasonography; Radionuclide renogram Abstract: To analyze the current management recommendations among French-speaking physicians treating infants with antenatal renal pelvis dilatation, we surveyed 83 pediatric nephrologists and 68 pediatric urologists by questionnaire. A total of 45 (54%) pediatric nephrologists and 38 (56%) pediatric urologists responded. The threshold for the diagnosis of abnormal fetal renal pelvis dilatation was significantly higher among pediatric urologists than nephrologists. All responders perform renal ultrasound examinations after birth. Postnatal renal pelvis dilatation was considered abnormal if the anteroposterior diameter was aY=11+-1.9 mm by the pediatric urologists and aY=9+-2.9 mm by the pediatric nephrologists (P=0.003). Pediatric urologists were more likely than nephrologists to recommend routine voiding cystourethrography [41% versus 20% (P=0.04)]. Mercaptoacetyl-triglycine renography was the most routinely used tool to achieve functional evaluation during follow-up among the responders. Pediatric urologists were more likely to recommend surgical treatment in dilated kidneys with initial function &lt 40%. In conclusion, pediatric urologists had significantly higher thresholds for the detection of prenatal and neonatal renal pelvis dilatation. They also more frequently recommended routine voiding cystourethrography and surgical therapy of dilated kidneys with low function than pediatric nephrologists. The variability in attitudes is most probably due to the absence of clear guidelines based on prospective and controlled trials. Author Affiliation: (1) Department of Perinatal and Pediatric Nephrology, Hopital Universitaire des Enfants--Reine Fabiola, Brussels, Belgium (2) Department of Perinatal and Pediatric Nephrology, Hopital Erasme, Brussels, Belgium (3) Department of Radiology, Hopital Erasme, Brussels, Belgium (4) Department of Radioisotopes, Centre Hospitalier Universitaire St. Pierre, Brussels, Belgium (5) Department of Nephrology, Hopital Erasme, Brussels, Belgium (6) Department of Pediatric Nephrology, Hopital Edouard Herriot, Lyon, France (7) Department of Pediatric Surgery, Centre Hospitalier Universitaire St. Jacques, Besancon, France (8) Department of Perinatal and Pediatric Nephrology, Hopital Universitaire des Enfants--Reine Fabiola, 15 Avenue J.J. Crocq, 1020 Brussels, Belgium Article History: Registration Date: 28/04/2004 Received Date: 29/01/2004 Accepted Date: 22/03/2004 Online Date: 06/07/2004 Article note: The following workers contributed to this study. For the French-speaking Society of Pediatric Nephrology (SNP): J. Al Hosri (Hopital Nord, Amiens, France), J.L. Andre (Hopital d'Enfants, Nancy, France), A. Bensman (Hopital Trousseau, Paris, France), E. Berard (L'Archet II, Nice, France), J.P. Bertheleme (Centre Helio Marin, Roscoff, France), F. Bouissou (Hopital des Enfants, Toulouse, France), G. Bourdat-Michel (CHU, Grenoble, France), G. Champion (CHU, Angers, France), S. Cloarec (Hopital Clocheville, Tours, France), L. Collard (Hopital E. Herriot, Lyon, France), J.C. Davin (Emma Children's Hospital, Amsterdam, Holland), L. de Parscau (Hopital Augustin Morvan, Brest, France), S. Decramer (Hopital des Enfants, Toulouse, France), V. Desvignes (CH, Clermont Ferrand, France), R. Donckerwolcke (AZ, Maastricht, Holland), J. Ehrich (MHH, Hannover, Germany), M. Fischbach (Hopital de Hautepierre, Strasbourg, France), M. Foulard (Hopital Jeanne de Flandre, Lille, France), M.S. Ghuysen (CHU Sart Tilman, Liege, Belgium), J.B. Gouyon (Hopital d'Enfants, Dijon, France), J.P. Guignard (CHUV, Lausanne, Switzerland), C. Guyot (CHU, Nantes, France), P. Hansen (Hopital Tivoli, La Louviere, Belgium), J.P. Hehunstre (Hopital Pellegrin, Bordeaux, France), F. Janssen (Hopital Universitaire des Enfants, Brussels, Belgium), M.J. Krier (Hopital d'Enfants, Nancy, France), A. Lahoche-Manucci (Hopital Jeanne de Flandre, Lille, France), H. La Selve (Centre Helio Marin, Roscoff, France), M.P. Lavocat (Hopital Nord, Saint Etienne, France), C. Loirat (Hopital Robert Debre, Paris, France), J. Lombet (CHR La Citadelle, Liege, Belgium), A. May (CH Sud Francilien, Evry, France), D. Morin (Hopital Arnaud de Villeneuve, Montpellier, France), J.B. Palcoux (Hotel Dieu, Clermont Ferrand, France), S. Palomera (CTMR, Bordeaux, France), C. Pietrement (American Memorial Hospital, Reims, France), S. Ploos van Amstel (Emma Children's Hospital, Amsterdam, Holland), W. Proesmans (UZ Gasthuisberg, Leuven, Belgium), N. Ranguelov (CHU, Charleroi, Belgium), B. Roussel (American Memorial Hospital, Reims, France), M.H. Said (Hopital E. Herriot, Lyon, France), A. Taque (Hopital de Pontchaillou, Rennes, France), M. Tsimaratos (Hopital La Timone, Marseille, France). R. Van Damme-Lombaerts (UZ Gasthuisberg, Leuven, Belgium) For the French-speaking Pediatric Urology Study Group (GEUP): T. Aivazoglou (Aglaia Kyriakou Hospital, Athens, Greece), J.L. Alain (CHU Dupuytren, Limoges, France), P. Alessandrini (Hopital Nord, Marseille, France), G. Audry (Hopital Trousseau, Paris, France), M. Averous (Hopital Lapeyronie, Montpellier, France), R. Besson (Hopital Jeanne de Flandre, Lille, France), J. Biserte (Hopital Huriez, Lille, France), B. Boillot (CHU Albert Michallon, Grenoble, France), J.M. Bondonny (Hopital des Enfants, Bordeaux, France), J.P. Bonnet (Hopital Simone Veil, Montmorency, France), P. Bugmann (Hopital des Enfants, Geneva, Switzerland), F. Collier (Hopital Universitaire des Enfants, Brussels, Belgium), J.F. Colombani (CHU, Fort-de-France, France), H. Dodat (Hopital E. Herriot, Lyon, France), B. Dore (CHU, Poitiers, France), A. El Ghoneimi (Hopital R. Debre, Paris, France), C. Esposito (Universitary Hospital, Naples, Italy), B. Fremond (Clinique Chirurgicale infantile, Rennes, France), P. Frey (CHUV, Lausanne, Switzerland), S. Geiss (Centre de la Mere et l'Enfant, Colmar, France), I. Germouty (CHU, Brest, France), Y. Heloury (CHU, Nantes, France), A. Lacombe (Hopital Clocheville, Tours, France), S. Lortat-Jacob (Hopital Necker-Enfants Malades, Paris, France), T. Merrot (Hopital Nord, Marseille, France), R. Moog (Hopital de Hautepierre, Strasbourg, France), G. Morisson-Lacombe (Hopital Saint Joseph, Marseille, France), J. Moscovici (Hopital des Enfants, Toulouse, France), P. Mouriquand (Hopital Debrousse, Lyon, France), E. Sapin (CHU, Dijon, France), A. Savanelli (Universitary Hospital, Catanzaro, Italy), M. Schmitt (Hopital d'Enfants, Nancy, France), H. Steyaert (Fondation Lenval, Nice, France), C. Tolg (CHU, Fort-de-France, France), J.S. Valla (Fondation Lenval, Nice, France), F. Varlet (Hopital Nord, Saint Etienne, France), P. Wallon (Centre de Chirurgie de l'Enfant, Bordeaux, France), D. Weil (Centre Hospitalier, Le Mans, France)

Byline: Elena Levtchenko (1), Cecile Lahy (2), Jack Levy (2), Hamphrey Ham (3), A. Piepsz (3) Keywords: Keywords Pyelonephritis; Urinary tract infection; Renal sequelae; Treatment; Randomization; Dimercaptosuccinic acid scintigraphy Abstract: The aim of this study was to compare, in children with acute pyelonephritis, the efficacy of 7 days' (group A) and 3 days' (group B) intravenous antibiotics, both followed by an oral treatment. Children were randomized after 3 days of intravenous treatment. Technetium-99m dimercaptosuccinic acid (DMSA) scintigraphy was performed within the first days after admission and repeated 6 months later. Total or partial persistence of renal abnormalities on the 6-month DMSA scintigraphy was used as the endpoint of the study. Among the 92 children included in the study, 87 were followed for at least 6 months (43 in group A and 44 in group B) and were eligible for analysis. Late DMSA was abnormal in 9 kidneys of group A and 12 kidneys of group B, representing respectively 24% and 44% of kidneys with abnormalities on the initial DMSA (difference statistically not significant). When the patients were stratified according to the delay of treatment, the percentage of patients with sequelae in group A was comparable, whether the delay was less or more than 1 week. In group B, the percentage of patients with sequelae was significantly higher (P&lt 0.01) when the delay was more than 1 week. Author Affiliation: (1) Department of Pediatrics, AZ VUB, Brussels, Belgium, BE (2) Department of Pediatrics, CHU St Pierre, Brussels, Belgium, BE (3) Department of Radioisotopes, CHU St Pierre, 290, Rue Haute, 1000 Brussels, Belgium. amypiepsz@yahoo.com, BE (4) Department of Nuclear Medicine, AZ VUB, Brussels, Belgium, BE Article note: Received: 2 January 2001 / Revised: 29 June 2001 / Accepted: 1 July 2001

Byline: Elena N. Levtchenko (1), Cecile Lahy (2), Jack Levy (2), H. R. Ham (3), Amy Piepsz (3) Keywords: KeywordsaUrinary tract infection; Acute pyelonephritis; Children; Negative urine culture; Technetium-99m dimercaptosuccinic acid; Tc-99m DMSA Abstract: The aim of this work was to evaluate prospectively the proportion of children with a clinical and biological presentation of acute pyelonephritis, abnormal Tc-99m dimercaptosuccinic acid (DMSA) scintigraphy and negative or equivocal urine cultures. All patients aged 6 weeks to 15 years suspected of acute pyelonephritis (APN) were admitted to the Paediatric Department and underwent Tc-99m DMSA scintigraphy within 3 days after admission and at 6 months. Of 166 patients enrolled in the study, 15 (9%) had negative or equivocal urine culture despite clinical and scintigraphic evidence of APN. Of these 15 children, renal ultrasound was normal in 7 patients and vesicoureteric reflux was found in 9 patients. Control DMSA 6 months after acute episode showed the disappearance of cortical lesions in eight and partial improvement in four patients. In this prospective series, as many as 9% of patients with APN would have been missed on the basis of equivocal or negative urine cultures. It is suggested that Tc-99m DMSA scintigraphy should be performed in children with severe infection without clear aetiology, especially in those with abnormal urinalysis. Author Affiliation: (1) Department of Paediatrics, Academic Hospital, Free University, Brussels, Belgium, BE (2) Department of Paediatrics, CHU St. Pierre, Brussels, Belgium, BE (3) Department of Nuclear Medicine, CHU St. Pierre, Brussels, Belgium, BE (4) CHU St. Pierre, Department of Radioisotopes, 290 Rue Haute, 1000 Brussels, Belgium e-mail: amypiepsz@yahoo.com Tel.: +32-2-5354564, Fax: +32-2-5353137, BE Article note: Received: 9 August 2000 / Revised: 12 January 2001 / Accepted: 25 January 2001

Byline: F. Arnello (1), H. R. Ham (3), M. Tondeur (3), A. Piepsz (1) Keywords: Key wordsaGlomerular filtration rate; Hyperfiltration; Urinary tract infection; Technetium 99m-dimercaptosuccinic acid scintigraphy; 51Chromium-EDTA Abstract: aThe aim of this study was to evaluate renal function during the acute phase of symptomatic urinary tract infection and the changes observed several months later. Overall glomerular filtration rate (GFR) as well as single kidney GFR (SKGFR) were calculated using the combination of a left/right uptake ratio obtained from technetium 99m-dimercaptosuccinic acid (DMSA) scintigraphy and 51.sup.chromium-EDTA plasma clearance. Forty-four patients with obvious unilateral or bilateral DMSA abnormalities were studied. In patients with unilateral lesions, both the overall GFR and the SKGFR were significantly higher during the acute phase of infection than several months later, on the abnormal side as well as the normal side. The relative percentage uptake was lower on the abnormal side than the normal side, obviously due to loss of functional parenchyma. This percentage increased significantly during the recovery phase, reflecting the total or partial healing of the renal lesions, despite the decrease of the corresponding SKGFR. However, during both the acute and the recovery phase, the relative percentage uptake of the abnormal kidney was in the normal range and often close to 50%. In patients with bilateral lesions, no significant changes were observed between the acute phase and the recovery phase. Author Affiliation: (1) Department of Nuclear Medicine, AZ VUB, Brussels, Belgium, BE (2) Department of Nuclear Medicine, San Juan de Dios Hospital, Santiago, Chile, CL (3) Department of Nuclear Medicine, CHU St. Pierre, 322, Rue Haute, B-1000 Brussels, Belgium, BE (4) Department of Pediatrics, AZ VUB, Brussels, Belgium, BE Article note: Received: 9 February 1998 / Revised: 16 June 1998 / Accepted: 17 June 1998