World journal of nuclear medicine · 2026
Tc-99m Renal Scintigraphy in Complex Congenital Systemic Syndromes Associated with Congenital Anomalies of the Kidney and Urinary Tract: A Retrospective Single-Center Study.
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Singh Deepa, Kumar Pramit, Jain Suruchi
Аннотация
OBJECTIVES: Congenital anomalies of the kidney and urinary tract (CAKUT) result from embryonic developmental defects and are usually not isolated. We evaluate the functional status of the kidney with Tc-99m renal scintigraphy in CAKUT patients associated with a rare complex systemic syndrome/sequence.
MATERIALS AND METHODS: We retrospectively screened 788 Tc-99m EC (ethylenedicysteine) and 187 Tc-99m DMSA (dimercaptosuccinic acid) renal scintigraphies performed between January 2022 and November 2024. Patients were selected based on the presence of congenital systemic syndrome and CAKUT.
STATISTICAL ANALYSIS: The Kruskal-Wallis test was used to compare grading of functional impairment of kidneys across different systemic syndromes. The Mann-Whitney U-test was used to compare the functional impairment of the kidney for continuous variables.
RESULTS: A total of 38 patients (23 males, 15 females, mean age: 6.7 ± 6.7, range 0.03-33 years) of congenital systemic syndrome with associated CAKUT were identified. The most common systemic syndrome was anorectal malformation in 15 patients (39.5%). A few patients had features of more than one syndrome. The most common CAKUT was an orthotopic or ectopic nonfunctioning kidney in 15 patients (39.5%). The Tc-99m renal scintigraphies showed abnormal findings in 31 patients and normal findings in 7 patients. The proportion of abnormal findings was 81.6% (95% confidence interval: 65.7-92.3%). The difference in proportion of abnormal findings of renal scintigraphy across different syndromes was not statistically significant (Fisher's exact test, p = 0.128). The Kruskal-Wallis H-test revealed significant differences in the grading of functional impairment of kidneys across different systemic syndromes, H(16) = 27.24, p = 0.039. The Mann-Whitney U-test revealed significant difference ( p = 0.007) in serum creatinine of normal Tc-99m scintigraphy (mean = 0.49, n = 7) and abnormal Tc-99m scintigraphy (mean =1.25, n = 31), U = 36.5, z = 2.71, r = 1.65. However, there was no significant difference ( p = 0.097) in the age of patients who showed normal and abnormal Tc-99m scintigraphies.
CONCLUSIONS: A complex systemic syndrome may have occult CAKUT that remains silent initially but presents as a complicated case later. Thus, these patients need functional evaluation with Tc-99m EC and Tc-99m DMSA scintigraphies for early diagnosis of renal anomaly and timely management and follow-up, especially after surgical intervention, to avoid future complications.
MATERIALS AND METHODS: We retrospectively screened 788 Tc-99m EC (ethylenedicysteine) and 187 Tc-99m DMSA (dimercaptosuccinic acid) renal scintigraphies performed between January 2022 and November 2024. Patients were selected based on the presence of congenital systemic syndrome and CAKUT.
STATISTICAL ANALYSIS: The Kruskal-Wallis test was used to compare grading of functional impairment of kidneys across different systemic syndromes. The Mann-Whitney U-test was used to compare the functional impairment of the kidney for continuous variables.
RESULTS: A total of 38 patients (23 males, 15 females, mean age: 6.7 ± 6.7, range 0.03-33 years) of congenital systemic syndrome with associated CAKUT were identified. The most common systemic syndrome was anorectal malformation in 15 patients (39.5%). A few patients had features of more than one syndrome. The most common CAKUT was an orthotopic or ectopic nonfunctioning kidney in 15 patients (39.5%). The Tc-99m renal scintigraphies showed abnormal findings in 31 patients and normal findings in 7 patients. The proportion of abnormal findings was 81.6% (95% confidence interval: 65.7-92.3%). The difference in proportion of abnormal findings of renal scintigraphy across different syndromes was not statistically significant (Fisher's exact test, p = 0.128). The Kruskal-Wallis H-test revealed significant differences in the grading of functional impairment of kidneys across different systemic syndromes, H(16) = 27.24, p = 0.039. The Mann-Whitney U-test revealed significant difference ( p = 0.007) in serum creatinine of normal Tc-99m scintigraphy (mean = 0.49, n = 7) and abnormal Tc-99m scintigraphy (mean =1.25, n = 31), U = 36.5, z = 2.71, r = 1.65. However, there was no significant difference ( p = 0.097) in the age of patients who showed normal and abnormal Tc-99m scintigraphies.
CONCLUSIONS: A complex systemic syndrome may have occult CAKUT that remains silent initially but presents as a complicated case later. Thus, these patients need functional evaluation with Tc-99m EC and Tc-99m DMSA scintigraphies for early diagnosis of renal anomaly and timely management and follow-up, especially after surgical intervention, to avoid future complications.