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

doi:10.1016/j.ajur.2019.03.003

Asian Journal of Urology, 2019, 6 (4): 359-363 doi: 10.1016/j.ajur.2019.03.003

Original Articles

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

Bimalesh Purkait^a,Apul Goel^a,*(

),Satyawati Deswal^b,Monica Agrawal^c,BhupendraPal Singh^a,Manoj Kumar^a

^a Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
^b Department of Nuclear Medicine, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
^c Department of Obstetrics and Gynaecology, King George's Medical University, Lucknow, Uttar Pradesh, India

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Abstract

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 2-3 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 (pre-instillation) 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.

Key words： Chyluria Endoscopic sclerotherapy Dimercaptosuccinic acid renal scan Relative renal function Renal scarring

Received: 22 May 2017 Available online: 19 March 2019

Corresponding Authors: Apul Goel E-mail: drapul.goel@gmail.com

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Bimalesh Purkait,Apul Goel,Satyawati Deswal, et al. Does endoscopic sclerotherapy in filarial chyluria affect renal function and morphology? A prospective study using dimercaptosuccinic acid renal scan[J]. Asian Journal of Urology, 2019, 6(4): 359-363.

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http://www.ajurology.com/EN/10.1016/j.ajur.2019.03.003 OR http://www.ajurology.com/EN/Y2019/V6/I4/359

Clinical and demographic parameters.

Comparison of renal function before and after instillation.

Dimercaptosuccinic acid renal scans. (A) Pre instillation renal scan with no scar; (B) Post instillations scan with renal scar at upper pole and poor uptake (white arrow).

[1]	Hemal AK, Gupta NP . Retroperitoneoscopic lymphatic management of intractable chyluria. J Urol 2002; 167:2473-6.
[2]	Ngan H, Yu HHY, Leong CH . A lymphographic study of chyluria. Br J Radiol 1977; 50:863-70.
[3]	Sharma G, Chitale V, Karva R, Sharma A, Durug AB . Fluoroscopy guided instillation therapy in chyluria using combination of povidone iodine with contrast agent. Is a single instillation sufficient? Int Braz J Urol 2008; 34:270-5.
[4]	Sabnis RB, Punekar SV, Desai RM, Bradoo AM, Bapat SD . Instillation of silver nitrate in the treatment of chyluria. Br J Urol 1992; 70:660-2.
[5]	Shanmugam TV, Prakash JV, Sivashankar G . Povidone iodine used as a sclerosing agent in the treatment of chyluria. Br J Urol 1998; 82:587.
[6]	Goel S, Mandhani A, Srivastava A, Kapoor R, Gogoi S, Kumar A , et al. Is povidone iodine an alternative to silver nitrate for renal pelvic instillation sclerotherapy in chyluria? BJU Int 2004; 94:1082-5.
[7]	Dash SC, Bhargav Y, Saxena S, Agarwal SK, Tiwari SC, Dinda A . Acuterenal failure and renal papillary necrosis following instillation of silver nitrate for treatment of chyluria. Nephrol Dial Transplant 1996; 11:1841-2.
[8]	Kulkarni AA, Pathak MS, Sirsat RA . Fatal renal and hepatic failure following silver nitrate instillation for treatment of chyluria. Nephrol Dial Transplant 2005; 20:1276-7.
[9]	Kumar M, Bhat HS . Experience with 5% AgNO3 instillation in chyluria. Indian J Surg 1975; 37:33-8.
[10]	Mandhani A, Kapoor R, Gupta RK, Rao HS . Can silver nitrate instillation for the treatment of chyluria be fatal? Br J Urol 1998; 82:926-7.
[11]	Moorin R . 99mTc-DMSA absolute uptake: normal pediatric values at 24 hours. J Nucl Med Technol 2001; 29:22-9.
[12]	Nepple KG, Knudson MJ, Austin JC, Cooper CS . Abnormal renal scans and decreased early resolution of low grade vesicoureteral reflux. J Urol 2008; 180:1643-7.
[13]	Goel TC, Goel A. Chyluria. In: Goel TC, Goel A, editors. Lymphatic filariasis. Springer: Singapore; 2016. p. 273-300.
[14]	Desai R . Complications and precautions of sclerotherapy. Indian J Urol 2005; 21:27-30.
[15]	Shanon A, Feldman W, McDonald P, Martin DJ, Matzinger MA, Shillinger JF , et al. Evaluation of renal scars by technetiumlabeled dimercapto-succinic acid scan, intravenous urography, and ultrasonography: a comparative study. J Pediatr 1992; 120:399-403.
[16]	Rossleigh MA . Renal cortical scintigraphy and diuresis renography in infants and children. J Nucl Med 2001; 42:91-5.
[17]	Bhatnagar V, Mitra DK, Agarwala S, Kumar R, Patel C, Malhotra AK , et al. The role of DMSA scans in evaluation of the correlation between urinary tract infection, vesicoureteric reflux, and renal scarring. Pediatr Surg Int 2002; 18:128-34.
[18]	Matsura H, Hioki T, Sakurai M, Arima K, Yanagawa M, Sugimura Y , et al. Influence of extracorporeal shock wave lithotripsy (ESWL) on renal function assessed by 99mTc-DMSA scintigraphy: comparative analysis between ESWL and percutaneous nephroureterolithotripsy (PNL). Hinuokyka Kiyo 1994; 40:1061-7.
[19]	Mousavi-bahar SH, Fazlian MM . Effect of percutaneous nephrolithotomy on renal function measured by Tc-99m-Dimercapto- Succinic cid renal scan. Internet J Nephrol 2010; 2:234-8.
[20]	Jacobson SH, Hansson S, Jakobsson B . Vesicoureteric reflux: occurrence and long term risks. Acta Paediatr Suppl 1999; 43:22-30.
[21]	Zaki M, Badawi M, Al Mutari G, Ramadan D, Adul Rahman M . Acute pyelonephritis and renal scarring in Kuwaiti children: a follow-up study using 99mTc DMSA renal scintigraphy. Pediatr Nephrol 2005; 20:1116-9.
[22]	Stokland E, Hellstróm M, Jacobson B . Early Tc-99m DMSA scintigraphy in symptomatic first-time urinary tract infection. Acta Paediatr 1996; 85:430-6.
[23]	Stokland E, Hellstro′m M, Jacobson B . Renal damage one year after first urinary tract infection, role of DMSA scintigraphy. J Pediatr 1996; 129:815-20.
[24]	Camacho V, Estorch M, Fraga G, Mena E, Fuertes J, Hernández MA , et al. DMSA study performed during febrile urinary tract infection:a predictor of patient outcome? Eur J Nucl Med Mol Imaging 2004; 31:862-6.