1/34. Radionuclide renography: a personal approach.Recent advances have increased the value of radionuclide renography in evaluating the patient with suspected disease of the genitourinary tract. The use of the consensus process to help standardize procedures and recommend interpretative criteria provides guidance for the nuclear medicine practitioner, serves as a basis to improve the standard of practice, and facilitates pooling of data from different centers. This review draws on the consensus criteria to present a personal approach to radionuclide renography with a particular emphasis on diuresis renography and the detection of renovascular hypertension. patients are encouraged to come well hydrated and void immediately prior to the study. Our standard radiopharmaceutical is 99mTc mercaptoacetyltriglycine (MAG3). Routine quantitative indices include a MAG3 clearance, whole kidney and cortical (parenchymal) regions of interest, measurements of relative uptake, time to peak height (Tmax), 20 min/max count ratio, residual urine volume and a T(1/2) in patients undergoing diuresis renography. A 1-minute image of the injection site is obtained at the conclusion of the study to check for infiltration because infiltration can invalidate a plasma sample clearance and alter the renogram curve. A postvoid image of the kidneys and bladder is obtained to calculate residual urine volume and to better evaluate drainage from the collecting system. In patients undergoing diuresis renography, the T(1/2) is calculated using a region of interest around the activity in the dilated collecting system. A prolonged T(1/2), however, should never be the sole criterion for diagnosing the presence of obstruction; the T(1/2) must be interpreted in the context of the sequential images, total and individual kidney function, other quantitative indices and available diagnostic studies. The goal of ACE inhibitor renography is to detect renovascular hypertension, not renal artery stenosis. patients with a positive study have a high probability of cure or amelioration of the hypertension following revascularization. In patients with azotemia or in patients with a small, poorly functioning kidney, the test result is often indeterminate (intermediate probability) with an abnormal baseline study that does not change following ACE inhibition. In patients with normal renal function, the test is highly accurate. To avoid unrealistic expectations on the part of the referring physician, it is often helpful to explain the likely differences in test results in these two-patient populations prior to the study.- - - - - - - - - - ranking = 1keywords = parenchymal (Clic here for more details about this article) |
2/34. Antiphospholipid antibody syndrome manifested as a postoperative cerebrovascular event in a child.Perioperative cerebrovascular events are exceedingly uncommon in pediatric patients. The etiology of such problems includes emboli from intracardiac thrombi, sickle cell disease, vascular anomalies, vasculitis affecting the cerebral vasculature, and prothrombotic states. We describe a 6-year-old boy who had right-sided hemiparesis on the second postoperative day after an uneventful patch angioplasty for renal artery stenosis. Workup revealed a possible hypercoagulable state due to an anticardiolipin antibody. The pathogenesis of the anticardiolipin antibody syndrome, its clinical manifestations, diagnostic criteria, and potential treatment strategies are reviewed.- - - - - - - - - - ranking = 0.50304103192921keywords = cerebral (Clic here for more details about this article) |
3/34. Superiority of tc-99m MAG3 to tc-99m DTPA in treating a patient with mild renal artery stenosis.A 22-year-old female patient with severe hypertension underwent both technetium-99m diethylenetriaminepentaacetate and technetium-99m mercaptoacetyltriglycine basal and captopril renal scintigraphy. While no significant change was seen with Tc-99m DTPA, there was left sided parenchymal retention of captopril Tc-99m MAG3 suggesting renal artery stenosis which was confirmed by angiography.- - - - - - - - - - ranking = 1keywords = parenchymal (Clic here for more details about this article) |
4/34. Combination thrombolytic and anticoagulant therapy for bilateral renal vein thrombosis in a premature infant.We report a premature infant with bilateral renal vein thrombosis and renal failure at 1 month of age who underwent treatment with recombinant tissue plasminogen activator and heparin sulfate. Combination thrombolytic and anticoagulation therapy was complicated by an intraventricular and intraparenchymal cerebral hemorrhage without resolution of the renal vein thrombosis. With increasing reports of successful use of this therapy for venous thrombosis, we suggest caution and continued study of its use in the premature infant and newborn.- - - - - - - - - - ranking = 1.5030410319292keywords = parenchymal, cerebral (Clic here for more details about this article) |
5/34. Polycythaemia and hypertension caused by renal artery stenosis.A girl with failure to thrive and a haemoglobin of 140 g/l at 1.3 years died from a brain haemorrhage 2.5 years later. renal artery stenosis had caused severe, chronic hypertension and increased erythropoietin secretion (haemoglobin 182 g/l). blood pressure should be measured in all unwell children, including those failing to thrive.- - - - - - - - - - ranking = 0.96734071494636keywords = haemorrhage (Clic here for more details about this article) |
6/34. renal artery stenosis and aneurysmatic dilatation of arteria carotis interna in tuberous sclerosis complex.hypertension in children with neurocutaneous disorders (phacomatoses) is a well-recognized complication of these diseases and the cause of hypertension is fairly specific within each group. In patients with neurofibromatosis, hypertension is mainly caused by renovascular disease, whereas in tuberous sclerosis (TSC) reasons for hypertension are renoparenchymal lesions, such as angiomyolipoma or cysts. We report on a girl with TSC and hypertension due to unilateral renal artery stenosis associated with aneurysmatic changes of internal carotid artery. This unusual combination of symptoms in our patient supports the importance of thorough and complete investigation of hypertension in children with phacomatoses.- - - - - - - - - - ranking = 1keywords = parenchymal (Clic here for more details about this article) |
7/34. renal artery stenosis and nephrotic syndrome: a rare combination in an infant.We describe an uncommon pediatric finding of unilateral renal artery stenosis, which presented as nephrotic syndrome, hypertension, failure to thrive, and hyponatremia. The child was a previously well 8-month-old male who looked well but had mild periorbital edema with severe hypertension. After 3 days of captopril therapy, the nephrotic-range proteinuria significantly improved. However, the hypertension persisted. Renal imaging revealed a small left kidney with reduced parenchymal uptake and no significant excretion. A renal angiogram demonstrated left renal artery stenosis with increased left renal vein renin activity. The hypertension resolved within 24 h of a left nephrectomy, but non-nephrotic-range proteinuria persisted for 8 months post operatively. pathology of the left kidney was consistent with fibromuscular dysplasia. Although a few glomeruli (1%) had changes consistent with focal segmental glomerulosclerosis, such a few abnormal glomeruli were unlikely to account for the nephrotic syndrome. hypertension-induced changes in the unaffected right kidney probably caused the nephrotic-range proteinuria.- - - - - - - - - - ranking = 1keywords = parenchymal (Clic here for more details about this article) |
8/34. Fatal hypertensive encephalopathy in a child with association of multicystic kidney and renal artery stenosis.At the age of 5 years, a boy with known multicystic dysplastic kidney disease showed signs of arterial hypertension with progress to fatal hypertensive encephalopathy. Arterial hypertension was refractory to antihypertensive therapy and the child lost consciousness. Computed tomography of the brain revealed multiple cerebral infarctions. Doppler ultrasound showed an elevation of blood flow in the main artery of the functioning kidney consistent with stenosis as a cause of hypertension. CONCLUSION: Arterial hypertension is a known complication of kidney disease. multicystic dysplastic kidney and renal artery stenosis is a potentially fatal association. Careful evaluation and monitoring, with special emphasis on blood pressure, should be performed in children with multicystic dysplastic kidney disease.- - - - - - - - - - ranking = 0.50304103192921keywords = cerebral (Clic here for more details about this article) |
9/34. Severe arteriosclerosis in the kidney of a cocaine addict.cocaine abuse has been associated with sudden cardiac death with coronary artery thrombosis with or without underlying vessel disease. Additional vascular beds thus far implicated in cocaine-associated arteriopathy include thoracic and abdominal aorta, and pulmonary, cerebral, and placental vessels; abnormalities include vasospasm, thrombosis, and accelerated atherosclerosis. We report the case of an adult male cocaine user with severe arteriosclerosis of renal vessels, and suggest that cocaine may also affect the renal vasculature.- - - - - - - - - - ranking = 0.50304103192921keywords = cerebral (Clic here for more details about this article) |
10/34. diagnosis of moyamoya disease with additional renal artery stenosis by colour coded Doppler sonography.moyamoya disease is a rare vascular anomaly of the cerebral arteries. The etiology of the disease has not yet been clearly identified. We report the noninvasive diagnosis of moyamoya disease in a patients with a very early onset of symptoms in infancy. The diagnosis was made by colour coded Doppler sonography and confirmed by angiography at the age of 6 months, following two episodes of cerebral infarction. A bilateral encephalodurosynangiosis was performed at the age of 7 months with subsequent slight improvement of the neurological deficits. Colour Doppler sonography revealed early vascularisation from the fascia temporalis graft into the arachnoid space. At the age of 10 months the patient developed arterial hypertension caused by left renal artery stenosis. Our case suggests, that in infancy moyamoya disease can be suspected noninvasively by colour Doppler sonography of the cerebral arteries. patients should be carefully screened for possible extracranial arterial stenoses which may develop in the course of time. Encephalodurosynangiosis seems to be a good therapeutic option for patients with severe neurological symptoms.- - - - - - - - - - ranking = 1.5091230957876keywords = cerebral (Clic here for more details about this article) |
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