TC(99M)-DMSA IMAGING WITH TOMOGRAPHY IN RENAL-TRANSPLANT RECIPIENTS WITH ABNORMAL LOWER URINARY TRACTS

This study examined whether renal parenchymal imaging using Tc-99m DMS A scintigraphy with tomography is a sensitive measure of renal scarrin g in renal transplant recipients with an abnormal lower urinary tract and whether such scars correlate with impairment of renal function. Th ree groups of patients were compared: group 1, patients with an abnorm al lower urinary tract and deteriorating renal function (n = 9); group 2, abnormal lower urinary tract and stable renal function (n = 5); an d group 3, normal lower urinary tract and deteriorating renal function (n = 8). Eight of the nine patients in group 1 had multiple scars vis ible on Tc-99m DMSA scans and this correlated with histology when a re nal biopsy was performed; the only patient without scars had a transpl ant glomerulopathy. The presence of scars was associated with either r aised intravesical pressures or recurrent urinary tract infections (UT Is). Only one patient in each of groups 2 and 3 had visible scars and both these patients had a history of recurrent UTIs. Patients in group 3 with deteriorating renal function due to chronic rejection document ed by biopsy did not have cortical scars visible with Tc-99m DMSA tomo graphy. Tc-99m DMSA scanning with tomography is a useful investigation in the management of renal transplant patients with declining renal f unction; multiple scars may indicate abnormal lower urinary tract func tion and are not seen in chronic rejection.