New strategy of color and power doppler sonography combined with DMSA in the assessment of acute pyelonephritis in infants.

BACKGROUND: The purpose of this study was to evaluate the clinical value of color and power doppler sonography (CPDS) when combined it with 99mTc-dimercaptosuccinic acid scintigraphy (DMSA) in assessment of acute pyelonephritis (APN) in infants. METHODS: A total of 79 children with APN admitted to our hospital from June 2016 to Jan 2019 were enrolled, including 52 boys and 27 girls, age range 1 month to 3 years old. All cases followed the diagnostic criteria for acute pyelonephritis and excluded anatomical abnormalities of urinary system. All 79 patients were examined by urinary ultrasonography (US), CPDS, and DMSA within 48 h of fever and analyzed the clinical value of combining the two methods in the assessment of APN in infants. RESULTS: Among 79 children, urinary ultrasonography revealed 2 cases of renal cortical echo changes, both located in the upper pole of the kidney, 24 cases of kidney enlargement, and 1 case of left kidney shrinkage. Ninety-five kidneys were shown to be diseased with DMSA, while 105 kidneys abnormal by CPDS. The sensitivity of CPDS was 69.4%, and the specificity was 38.1%. In children younger than 6 months, the sensitivity of CPDS was 56.9%, which was 84.2% in childeren between 6 months to 1 year, and 94.4% from 1 to 3 years old, respectively. The corresponding specificity of CPDS was 44.1, 26.7, and 35.7%. There was no significant correlation between CPDS levels and DMSA positive results. The abnormal rate of intermediate part in the kidneys was significantly lower than that in the upper and lower poles. Children with abnormal CPDS have a greater risk of renal scarring(p < 0.05). CONCLUSION: Abnormalities detected by CPDS in a cohort of infants with APN poorly correlated with DMSA findings. But the sensitivity of CPDS is highly age-related, it can be used as a non-invasive helpful tool for early diagnosis of acute pyelonephritis in infants older than 6 months old.

[Renal expression of macrophage migration inhibitory factor in children with Henoch-Sch-nlein purpura nephritis].

OBJECTIVE: To examine the expression of macrophage migration inhibitory factor (MIF) in renal tissues obtained from children with Henoch-Sch-nlein purpura nephritis (HSPN). METHODS: The renal tissue samples were obtained from 11 children with different pathological grades of HSPN and 8 children with thin glomerular basement membrane disease (controls). The MIF expression was measured by immunohistochemistry. The correlation between MIF expression and 24 hrs urinary protein excretions was evaluated using a linear correlation analysis. RESULTS: MIF expression was seldom found in renal tissues obtained from controls. However, a significantly increased MIF expression was found and was concordant with the increased severity of renal pathology in renal tissues obtained from children with HSPN. The MIF expression in renal tissues of grade III-IV of renal pathology was significantly higher than that in grade I-II in children with HSPN (p<0.01). In children with HSPN, there was an increased MIF expression in renal tissues with crescent formation and inflammatory cell infiltration. Renal MIF expression was significantly positively correlated with 24 hrs urinary protein excretions in children with HSPN (p<0.01). CONCLUSIONS: MIF may play an important role in renal injury of HSPN. Up-regulation of MIF expression may reflect the degree of renal lesions in HSPN.