Prognosis And Outcome Of Children With Renal Dysfunction Caused By Dynamic Renography Evaluation Taking Melamine Contaminated Milk Powder

2008,our country taking melamine contaminated milk powder incident,the incident caused some infants suffering from melamine urinary stones andurinary tract hydrocephalus, caused by a small number of children with severerenal impairment, prognosis and outcome of the situation of these childrenhave been scholarsthe focus of attention.Dynamic renography can display the the kidneys position, size and shape,but also of renal perfusion, function dynamic and qualitative and quantitativeanalysis of the upper urinary tract patency, especially in the judgment of renalfunction with high sensitivity and accurategood, but also the determination ofkidney function. advantages, and thus become important inspection methodfor evaluation of renal function.Objective: This study of illness at that time part of renal damage inchildren with renal dynamic imaging, combined with urinary tract ultrasound,renal function, serum electrolytes, liver function, urinalysis and a series ofchecks, and children with renal dynamic imaging resultscomparative analysisbefore treatment, the visits taking melamine contaminated milk powder causedthe prognosis and outcome of renal damage in children. Reference processingmethods and treatment options for the future treatment of similar incidents.Methods:2008.10-2008.12melamine urinary calculi or hydronephrosiswere followed up at our hospital "F-15" diuretic dynamic renography of35patients,20males,15females, age （4-59） months, The average age of （10.31±3.56） months. After discharge follow-up children during hospitalization,clinic situation, parallel tehchnetium-99m diethylenetriaminepentaacetic acid（99mTc-DTPA）"F-15" diuretic renal dynamic imaging, and normal renalfunction, serum electrolytes, liver function urine, urinary tract ultrasonography. Children with simultaneous measurement of height and weight.1Dynamic renographyChildren of all follow-up, normal eating, drinking, check before30mindrinking10ml/kg body weight,15min before the injection of diuretics1mg/kgbody weight,check the front air bladder. Subjects supine position, collectedafter digital images. Vision, including kidneys, bladder."Projectile" injectionof99mTc-DTPA. U.S. company GE InfiniavcHawkeye II SPECT/CT imaginginstrument immediately after injection, dynamic acquisition.Using computer region of interest （ROI） technology are outlined the renalcontour extrarenal background, the abdominal aorta District renal blood flow,generated by computer software （children） perfusion curve, the renogram andrelated quantitative parameters obtained in kidney blood perfusion rate（perfusion）, stars renal function （uptake）, half time (C_1/2), pelvic excretionefficiency(R₂₀/Rmax,R₂₀/3), glomerular filtration rate （GFR）.Dynamic renography results and quantitative parameters, comparemelamine changes in renal function in children, before and after treatment.And the corresponding parameters were statistically analyzed.2Others2.1Urinary tract ultrasonographyThe observed subjects kidney size,parenchymal thickness,with or withoutstones, hydronephrosis and renal pelvis separation and analysis changes.2.2Serological testsThe patients were fasting venous blood, determination of serumcreatinine （Scr）, blood urea nitrogen （BUN）, β₂-microglobulin （β₂-MG）,potassium （K+）, a sodium ion （Na+）, chloride ion （Cl-）, magnesium ion(Mg²⁺),alanine aminotransferase （ALT）, aspartate aminotransferase （AST）,concentration.2.3Urine routine examinationPatients were collected early morning clean urine, determination ofurinary pH value, specific gravity, microscope, red blood cell （RBC）, whitecell（WBC）,urine protein. Result:1General informationThe study selected35cases in children, and a successful follow-up of29patients.Prevalence of dynamic renography results showed:22cases ofchildren with single kidney with impaired renal function,7cases of childrenwith bilateral renal dysfunction, of36suffering from kidney.4suffering fromkidney minutes kidney function normal, impaired excretory function;13suffering from kidney sub mild renal impairment associated with impairedexcretory function;16suffering from kidney sub impaired renal function withmoderate dysfunction associated with excretory;3points renal severe renal byloss, associated with impaired excretory function.2Dynamic renography2.1Qualitative results29patients were followed up children with renal （36）35suffering fromkidney renal function. Significant improvement （35/36, accounting for97.22%）,1suffering from renal no significant improve （1/36,accounting for2.78%）.2.2The quantitative results①Unilateral children with impaired renal function （n=22） perfusion,uptake changesSick at that time suffering from renal perfusion is （43.93±6.89）%, afterthree years, suffering from renal perfusion is （48.09±7.49）%, before and aftercomparison, the difference was statistically significant （Z=-2.516,P=0.012<0.05）.15suffering increased renal perfusion,7renals with reducedrenal perfusionSick at that time suffering from renal uptake is （41.09±7.10）%, after threeyears, suffering from renal uptake （45.88±10.19）%, before and aftercomparison, the difference was statistically significant（Z=-3.100,P=0.002<0.05）.19suffering increased renal uptake,3renals with reducedrenal uptake.②29cases follow-up of children with GFR, R₂₀/Rmax, R₂₀/3changes Sick at that time suffering from renal GFR is （49.04±12.89） ml/min,after three years, suffering from renal GFR is （56.98±11.18） ml/min, beforeand after comparison, the difference was statistically significant （Z=-3.331,P=0.001<0.05）.28suffering from renals GFR values increased,8renals GFRvalue decreases.Sick at that time suffering from kidney R₂₀/Rmaxis （0.73±0.17）%, afterthree years, suffering from renal R₂₀/Rmaxis （0.52±0.14）%, before and aftercomparison, and the difference was statistically significant （Z=3.669,P=0.000<0.05）.30suffering from renals R₂₀/Rmaxreduced,6renals R₂₀/Rmaxincrease.Sick at that time suffering from renal R₂₀/3is （0.87±0.40）%, after threeyears, suffering from renal R₂₀/3is （0.57±0.19）%, before and after comparison,the difference was statistically significant （Z=3.52, P=0.000<0.05）.31suffering from renals R₂₀/3reduced,5renals R₂₀/3increase.③Follow-up in children suffering from renal （36renals） C_1/2changes:Sick at that time suffering from renals C_1/2>20min; after three years,28suffering from renals C_1/2<10min,7renals C_1/2ranged from10min to20min,1renal C_1/2>20min.④22cases of unilateral renal damage in children prevalence ofperfusion and uptake level of GFR change the value of the relationship: theprevalence of renal perfusion and GFR change in a positive correlation （rs=0.478,P=0.024<0.05）; illness uptake and GFR change value was no significantcorrelation （rs=0.112, P=0.619>0.05）.⑤Suffering from renal GFR value of change taking melaminecontaminated milk powder time relationship: the left and right sides sufferingfrom renal GFR change values and taking time showed no significantcorrelation （rs=-0.283, P=0.190>0.05; rs=0.233, P=0.444>0.05）.3Others29cases of children with urinary tract ultrasonography were nosignificant positive stones, including1child with bilateral hydronephrosis,1child with unilateral hydronephrosis,2patients with bilateral renal pelvis separation,2patients with unilateral renal pelvis separation,1patientsuffering from renal atrophy, cortical thinning （singleside）,3patients sufferingfrom kidney compared with the contralateral slightly smaller （unilateral）; allthe children BUN, Scr, β-2-MG, K⁺, Na⁺, Cl, Mg²⁺, ALT and AST levels werein the normal range; all the children urinary pH value, specific gravity,RBC,WBC and urine protein were in the normal range.Conclusion:1Taking melamine contaminated milk powder caused damage to theurinary tract in critically ill children with renal prognosis is good.^299mTc-DTPA renal dynamic imaging in monitoring renal functioninfants than conventional inspection methods （serology, urinalysis, urinarytract ultrasound, etc.） sensitive and accurate for the evaluation of renalfunction has a unique advantage.