Does endoscopic sclerotherapy in filarial chyluria affect renal function and morphology? A prospective study using dimercaptosuccinic acid renal scan

Objective:To look for change in relative renal function and document renal scarring following endoscopic renal pelvic instillation sclerotherapy(RPIS)in patients with chyluria by dimercaptosuccinic acid(DMSA)renal scan.Methods:A prospective study was performed between November 2015 and September 2016.All patients with biochemically documented chyluria who underwent RPIS using either 1%-silver nitrate or 0.1%-povidine iodine were included.Patients received either 3-,6-or 9-doses.DMSA renal scan was performed before and 2e3 months after sclerotherapy.Results:Of the 34 patients,22 were males.Mean age was 41.08±16.64 years(range,15-70 years).Thirty-two patients(94.1%)responded to therapy while two did not respond even after 9-doses.Average follow-up was 8.94±3.70 months.The mean relative renal function(preinstillation)of normal kidney was 50.76%±3.55%while that of affected renal unit(side of instillation)was 49.20%±3.44%(range,43.0%-61.0%).After instillation therapy,the mean relative renal function of normal side was 52.26%±3.57%while that of affected renal unit was 47.50%±3.56%(range,41.0%-54.0%).The relative renal function did not change>5%from the baseline value in any patient except one(in which the differential function increased paradoxically by 12%).Two patients developed renal scar in post-instillation renal scan.Conclusion:Endoscopic sclerotherapy in chyluria is safe and effective.The relative renal function does not deteriorate by more than 5%.There is a small risk of development of renal scar.More studies involving larger number of patients are needed to answer this dilemma.

Role of scintigraphy in inflammatory bowel disease

The diagnosis of inflammatory bowel disease(IBD) depends on direct endoscopic visualization of the colonic and ileal mucosa and the histological study of the obtained samples.Radiological and scintigraphic methods are mainly used as an adjunct to endoscopy.In this review,we focus on the diagnostic potential of nuclear medicine procedures.The value of all radiotracers is described with special reference to those with greater experience and more satisfactory results.Tc-99m hexamethylpropylene amine oxime white blood cells remain a widely acceptable scintigraphic method for the diagnosis of IBD,as well as for the evaluation of disease extension and severity.Recently,pentavalent Tc-99m dimercaptosuccinic acid has been recommended as an accurate variant and a complementary technique to endoscopy for the follow-up and assessment of disease activity.Positron emission tomography alone or with computed tomography using fluorine-18 fluorodeoxyglucose appears to be a promising method of measuring inflammation in IBD patients.