title: Pediatric left renal vein entrapment syndrome diagnosed by 99mTc-albumin-conjugate scintigraphy.
abstract: OBJECTIVE
  Procedures for diagnosis of left renal vein entrapment syndrome (LRVES) in children have been either invasive or limited in accuracy. We examined scintigraphy with (99m)Tc-diethylene triamine pentaacetic acid-conjugated human serum albumin ((99m)Tc-HSA-D) scintigraphy in childhood LRVES, demonstrating selective left renal nuclides excretion. We also measured peak velocity using pulse Doppler ultrasonography, calculating pressure differences between inferior vena cava and left renal vein using a simplified Bernoulli equation.
  
  
  METHODS
  Thirteen patients provisionally diagnosed with LRVES by ultrasonography combined with other imaging such as magnetic resonance angiography and three-dimensional computer tomography (CT) were examined.
  
  
  RESULTS
  Four children showing repeated gross hematuria all showed pressure differences exceeding 3.0 mm Hg. Selective left renal albumin excretion was demonstrated by (99m)Tc-HSA-D scintigraphy. Single-photon emission CT also showed accumulation in a site consistent with the left renal pelvis. Among 9 children manifesting mainly orthostatic proteinuria, selective left renal albumin excretion examined by (99m)Tc-HSA-D scintigraphy was demonstrated only in those with proteinuria exceeding 1 g/g Cr after standing in a lordotic position. Pressure differences in patients with orthostatic proteinuria were unrelated to proteinuria severity.
  
  
  CONCLUSIONS
  Combining pulse Doppler ultrasonography with (99m)Tc-HSA-D scintigraphy, both noninvasive and safe in children, may suffice for diagnosis of LRVES, especially with gross hematuria.
authors.affiliation: Department of Pediatrics, Kinki University Faculty of Medicine, Osaka-Sayama, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Sugimoto
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Fujita
authors.forename: Tomoki
authors.initials: T
authors.lastname: Miyazawa
authors.forename: Hitomi
authors.initials: H
authors.lastname: Nishi
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Okada
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Takemura
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D019275:Radiopharmaceuticals; D059228:Renal Nutcracker Syndrome / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013668:Technetium Tc 99m Aggregated Albumin; D016284:Technetium Tc 99m Pentetate; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
chemical_list: D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; C057162:technetium Tc 99m DTPA HSA; D016284:Technetium Tc 99m Pentetate