Color Doppler dynamic tissue perfusion measurement: a novel tool in the assessment of renal parenchymal perfusion in children with vesicoureteral reflux.
BACKGROUND
Vesicoureteral reflux (VUR) occurs in 20-50% of children suffering from recurrent urinary tract infections (UTIs) and is associated with an increased risk of renal scarring and impaired renal function. Early detection of renal perfusion deterioration would allow for the implementation of more aggressive treatment and potentially prevent further damage to the renal parenchyma. The aim of the study was to assess renal parenchymal perfusions in children with recurrent UTIs with and without coexisting VUR, and compare the findings with the results of healthy patients.


METHODS
Color Doppler sonographic dynamic renal parenchymal perfusion measurements were performed with PixelFlux (Chameleon-Software, Germany) software in 77 children with recurrent UTIs and coexisting VUR and in 30 children with UTIs without VUR. The findings were compared with the results of 53 healthy children.


RESULTS
Cortical parenchymal perfusion of children suffering from UTIs and VUR was significantly reduced when compared to the control group. Statistically significant differences (p < 0.05) were found in all perfusion parameters (i.e. mean velocity (v mix ), mean perfused area (A mix ), mean perfusion intensity (I mix ), tissue pulsatility index (TPI), and tissue resistance index (TRI)) between the control group and children suffering from UTIs and VUR, particularly VUR grades III and IV. There were no significant differences between the UTI group and the control group. No differences were found between the controls and VUR grade II.


CONCLUSIONS
Renal parenchymal perfusion decreases significantly with higher grades of VUR.
Department of Pediatric Radiology, Medical University of Lublin, Lublin, Poland.
Magdalena M
MM
Woźniak
Hospital for Children and Adolescents, Chemnitz Clinics, Chemnitz, Germany.
Thomas M
TM
Scholbach
University of Münster, Münster, Germany.
Jakob
J
Scholbach
Department of Pediatric Radiology, Medical University of Lublin, Lublin, Poland.
Agata
A
Pawelec
Department of Pediatric Surgery and Traumatology, Medical University of Lublin, Lublin, Poland.
Paweł
P
Nachulewicz
Department of Pediatric Radiology, Medical University of Lublin, Lublin, Poland.
Andrzej P
AP
Wieczorek
Department of Pediatric Radiology, Medical University of Lublin, Lublin, Poland.
Agnieszka
A
Brodzisz
Department of Pediatric Nephrology, Medical University of Lublin, Lublin, Poland.
Maria M
MM
Zajączkowska
Department of Pediatric Nephrology, Medical University of Lublin, Lublin, Poland.
Halina
H
Borzęcka
PixelFlux; renal parenchymal perfusion; urinary tract infections; vesicoureteral reflux