Objective-To evaluate the role of vitamin A on renal scarring in recurrent urinary tract infections (UTIs). Design-Twenty three children with UTIs and renal scarring (mean (SD) age 7.3 (3.9) years) and 91 children without renal scarring (6.4 (3.4) years) were studied. All the children had serum vitamin A and -carotene measurements and nutritional evaluation. Renal scarring was assessed by technetium-99m dimercaptosuccinic acid ( The role of vitamin A in recurrent urinary tract infections (UTIs) and urolithiasis has been assessed previously.1 Vitamin A was proposed as eVective in the regeneration of epithelial tissue in the urinary tract 2 ; -carotene has been reported to have antioxidant properties.3 Technetium 99-m dimercaptosuccinic acid ( 99m Tc DMSA) scintigraphy is the gold standard for demonstration of scarring in renal cortical tissue. 4 We hypothesised that the regenerative eVect of vitamin A on epithelial tissue could also be considered to play a part on renal parenchymal epithelium, as in the case of epithelium lining the lower urinary tract. The aim of this study was to evaluate the relation between vitamin A metabolism and scarred and unscarred renal parenchymal tissues and also to evaluate whether vitamin A and -carotene had an eVect on prevention of renal scarring.
Subjects and methodsChildren with renal scarring due to recurrent UTIs were enrolled in this study. A control group was composed of children with recurrent UTIs but without renal scarring.Each patient was evaluated twice by 99m Tc DMSA scans performed at least six months apart. Persisting hypodense areas on two consecutive DMSA scans were considered as renal scarring. 4 Patients with normal or nonpersisting DMSA findings were considered as free of scarring. Uptake of each kidney was determined as per cent of total uptake of both kidneys which was considered to be 100%. When the diVerence between uptakes of kidneys exceeds 10% on scanning, renal function was considered to be diminished on the lower uptake side. 4 All the scans were read blindly by two specialists.Nutritional status of patients was evaluated by body mass index and the results were compared with published standards.Vitamin A and -carotene concentrations were measured by the Neeld and Pearson method in venous blood samples obtained during acute UTI episodes. 5 The intrabatch coeYcients of variation for vitamin A and -carotene were 6.5% and 7.8 % respectively in preliminary standardisation.Patients were grouped according to whether they had renal scarring (study group) or not (control group). The groups were compared for serum vitamin A and serum -carotene concentrations and nutritional status. In addition, the extent of kidney scarring was compared with serum concentrations of vitamin A and -carotene, when the diVerence between 99m Tc DMSA uptakes of kidneys was greater than 10%.Results were analysed by unpaired t test and correlation analysis.
ResultsThere were 23 children with renal scars (mean (SD) age 7.3 (3.9) years and 91 unscarred children (mean age 6.4 (4.4) ...
Technetium-99m hexakis-2-methoxyisobutylisonitrile (MIBI) and thallium-201 imaging was performed in a patient with metastatic renal cell carcinoma (RCC), which is a well-known tumour type demonstrating P1-glycoprotein (PGP) overexpression. Two scintigraphic patterns - Tl(+)/MIBI(-) in primary tumour and Tl(+)/MIBI(+) in metastatic tumour - were observed, suggesting high- and low-level PGP expression, respectively. Immunochemical study for PGP revealed strong staining of the primary tumour cells. This case clinically validates the previously suggested relationship between 99mTc-MIBI uptake and PGP expression.
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