Detection of permanent damage in kidneys with vesicoureteral reflux by quantitative single photon emission computerized tomography (SPECT) uptake of 99mtechnetium labeled dimercaptosuccinic acid.

Abstract

We determined the level of functional damage to the kidney which inhibits further growth. Renal functional volume and percent uptake of 34 kidneys with reflux were studied by performing sequential quantitative single photon emission computerized tomography 2 times at a mean interval of 3.2 years. Change in volume between the initial and repeat studies was 27.2 +/- 28.4% in all 34 kidneys. Change in volume was less than 7% in 8 kidneys and greater than 14% in 26. Receiver operating characteristic curve analysis indicated that 15.6% kidney uptake was associated with 75% sensitivity, 100% specificity and 94% accuracy in distinguishing kidneys with more than 7% from those with less than 7% change in volume. The value of kidney uptake of less than 15.6% was 100% in predicting less than 7% change in volume (positive predictive value) and the value of kidney uptake greater than 15.6% was 93% in predicting more than 7% change in volume (negative predictive value). Kidney uptake of less than 15.6% represents irreversible impairment of renal growth and indicates permanent damage in kidneys with vesicoureteral reflux.