Effect of Chronic, Low-Pressure, Sterile Vesicoureteral Reflux on Renal Growth and Function in a Porcine Model: A Radiologic and Pathologic Study1
Harriet J. Paltiel, MD,
Robert V. Mulkern, PhD,
Antonio Perez-Atayde, MD,
Leonard P. Connolly, MD,
David Zurakowski, PhD,
S. Ted Treves, MD and
Anthony Atala, MD
1 From the Departments of Radiology (H.J.P., R.V.M., L.P.C., S.T.T.), Pathology (A.P.A.), Biostatistics (D.Z.), and Urology (A.A.), Children’s Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA 02115. Received December 9, 1999; revision requested January 5, 2000; revision received February 18; accepted February 23. Supported in part by a grant from the Society for Pediatric Radiology Research and Education Foundation. Address correspondence to H.J.P. (e-mail: harriet.paltiel@tch.harvard.edu).
View larger version (179K):
[in a new window]
|
Figure 1a. Grade 3 VUR in a pig. (a) Fluoroscopic anteroposterior voiding cystourethrogram of the pelvis shows contrast material in the bladder (asterisk) and in a mildly dilated distal right ureter (arrows). (b) Fluoroscopic anteroposterior voiding cystourethrogram obtained in the same pig reveals contrast material in a mildly dilated right renal collecting system and proximal ureter (arrows).
|
|
View larger version (160K):
[in a new window]
|
Figure 1b. Grade 3 VUR in a pig. (a) Fluoroscopic anteroposterior voiding cystourethrogram of the pelvis shows contrast material in the bladder (asterisk) and in a mildly dilated distal right ureter (arrows). (b) Fluoroscopic anteroposterior voiding cystourethrogram obtained in the same pig reveals contrast material in a mildly dilated right renal collecting system and proximal ureter (arrows).
|
|
View larger version (84K):
[in a new window]
|
Figure 2a. (a) Coronal posterior 99mTc-DMSA SPECT image obtained in a pig before reflux was created demonstrates normal baseline differential uptake of the radionuclide—54% in the left kidney and 46% in the right kidney. (b) Coronal posterior 99mTc-DMSA SPECT image at follow-up after the creation of reflux in the same pig depicts a decrease in right renal uptake to 38%, with 62% uptake in the left kidney.
|
|
View larger version (84K):
[in a new window]
|
Figure 2b. (a) Coronal posterior 99mTc-DMSA SPECT image obtained in a pig before reflux was created demonstrates normal baseline differential uptake of the radionuclide—54% in the left kidney and 46% in the right kidney. (b) Coronal posterior 99mTc-DMSA SPECT image at follow-up after the creation of reflux in the same pig depicts a decrease in right renal uptake to 38%, with 62% uptake in the left kidney.
|
|
View larger version (139K):
[in a new window]
|
Figure 3a. (a) Transverse nonenhanced CT scan obtained in a pig just prior to sacrifice demonstrates two right renal parenchymal regions of interest. Parenchymal enhancement is uniform on the corresponding CT scans obtained (b) 30 seconds and (c) 90 seconds after intravenous administration of contrast material.
|
|
View larger version (155K):
[in a new window]
|
Figure 3b. (a) Transverse nonenhanced CT scan obtained in a pig just prior to sacrifice demonstrates two right renal parenchymal regions of interest. Parenchymal enhancement is uniform on the corresponding CT scans obtained (b) 30 seconds and (c) 90 seconds after intravenous administration of contrast material.
|
|
View larger version (161K):
[in a new window]
|
Figure 3c. (a) Transverse nonenhanced CT scan obtained in a pig just prior to sacrifice demonstrates two right renal parenchymal regions of interest. Parenchymal enhancement is uniform on the corresponding CT scans obtained (b) 30 seconds and (c) 90 seconds after intravenous administration of contrast material.
|
|
View larger version (145K):
[in a new window]
|
Figure 4a. (a) Transverse nonenhanced T1-weighted spin-echo MR image (500/9) obtained in a pig just prior to sacrifice depicts two right renal parenchymal regions of interest. (b) On the corresponding contrast-enhanced T1-weighted MR image (500/9), parenchymal enhancement is uniform.
|
|
View larger version (149K):
[in a new window]
|
Figure 4b. (a) Transverse nonenhanced T1-weighted spin-echo MR image (500/9) obtained in a pig just prior to sacrifice depicts two right renal parenchymal regions of interest. (b) On the corresponding contrast-enhanced T1-weighted MR image (500/9), parenchymal enhancement is uniform.
|
|
View larger version (161K):
[in a new window]
|
Figure 5. Histologic section of the renal cortex from a refluxing pig kidney reveals lymphocytes and plasma cells in the tubular interstitium (arrowheads), with focal glomerular fibrosis (arrows). (Hematoxylin-eosin stain; original magnification, x20.)
|
|
Copyright © 2000 by the Radiological Society of North America.
