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He Y, Li Y, Sun J, Yang J, Song H, Zhang W. Ureteropelvic junction obstruction with polyps in children: clinical manifestations and supranormal preoperative differential renal function. Int Urol Nephrol 2024; 56:373-380. [PMID: 37833596 DOI: 10.1007/s11255-023-03827-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/29/2023] [Indexed: 10/15/2023]
Abstract
OBJECTIVE To describe and analyze the clinical manifestation and pre-DRF of UPJO children with polyps and explore the possible influencing factors of supranormal pre-DRF. PATIENTS AND METHODS All patients undergoing primary Anderson-Hynes pyeloplasty for UPJO due to polyp were retrospectively reviewed. Patients' characteristics, parameters of ultrasound and dynamic renograms (DR) were recorded in elaborate. Pre-DRF in groups of different age, weight, gender, pain, grade of hydronephrosis, anterio-posterior pelvic diameter (APD), length of kidney and postoperative ultrasonic parameters were compared. RESULTS A total of 18 UPJO children with polyps were included. Five (27.78%) patients had SFU III grade of hydronephrosis. Seven (38.89%) patients were supranormal pre-DRF. All patients had pre-DRF > 40%. Drainage curve was delayed excretion in 12 (66.67%) patients and T1/2 < 20 min was in 4 (22.22%) patients. Among the 16 patients who underwent preoperative IVP examination, 15 (93.75%) patients had concentration of intrarenal pelvis contrast agent within 10 min. No significant difference in post-APD reduction rate and post-minPT increased was found between supranormal pre-DRF and non-supranormal pre-DRF groups. The supranormal pre-DRF was more likely to occur in young and low-weight children. CONCLUSION The preoperative renal function of UPJO patients with polyps was well preserved, and 38.89% of them had supranormal pre-DRF. Patients with supranormal pre-DRF can be managed with the same strategies as those with normal renal function.
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Affiliation(s)
- Yuzhu He
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, No. 56 Nanlishi St, Xicheng District, Beijing, 100045, China
| | - Yi Li
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, No. 56 Nanlishi St, Xicheng District, Beijing, 100045, China
| | - Jihang Sun
- Department of Imaging, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Jigang Yang
- Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Hongcheng Song
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, No. 56 Nanlishi St, Xicheng District, Beijing, 100045, China
| | - Weiping Zhang
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, No. 56 Nanlishi St, Xicheng District, Beijing, 100045, China.
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Värelä S, Jakobsson C, Persson E, Börjesson A, Hagander L, Salö M. Supranormal differential renal function on MAG3 scan in children with ureteropelvic junction obstruction - Prevalence and pyeloplasty during follow-up. J Pediatr Urol 2023; 19:778.e1-778.e8. [PMID: 37726189 DOI: 10.1016/j.jpurol.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 07/31/2023] [Accepted: 08/08/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Children with suspected ureteropelvic junction obstruction (UPJO) may present with a paradoxical ipsilateral supranormal differential renal function (snDRF) on 99mTechnetium mercaptoacetyltriglycine scintigraphy (MAG3 scan). OBJECTIVE The aim was to investigate the prevalence of snDRF, the risk of pyeloplasty among children with UPJO and snDRF, and to explore the experience of snDRF among international pediatric urologists. METHODS A retrospective cohort study of children with suspected unilateral UPJO who underwent MAG3 scan at four hospitals in Sweden between 2005 and 2020. SnDRF was defined as DRF ≥55%. Normal DRF was defined as DRF 45-54%. Primary outcome was risk of pyeloplasty. Indications for pyeloplasty were loss of >10%-points of differential renal function (DRF), ipsilateral DRF <40%, or symptomatic UPJO. Logistic and cox regressions were performed in univariate and multivariable analyses, adjusting for age, gender, year, laterality, antenatal hydronephrosis, anterior-posterior diameter (APD), and kidney size. An international questionnaire regarding the management of snDRF was developed and distributed to pediatric urologists. RESULTS The prevalence of snDRF was 19%. SnDRF was more common in boys, children with antenatal hydronephrosis, children undergoing their first MAG3 scan at a younger age, and in the left kidney. After further exclusion of 70 children with DRF <45%, a total of 264 were included for longitudinal follow-up of median 6.6 (IQR 2.5-11.5) years. SnDRF was not associated with increased risk of pyeloplasty (adjusted OR 0.98 (95% CI 0.41-2.33), p = 0.96, and adjusted HR 1.00 (95% CI 0.53-1.91), p = 0.99) or time to pyeloplasty (1.1 years vs. 1.6 years, p = 0.40). Among the 79 surveyed pediatric urologists, a majority would not change clinical UPJO-management based on the presence or absence of ipsilateral snDRF. DISCUSSION There are only a few studies considering the need of pyeloplasty based on the presence of snDRF and this is the first survey among pediatric urologists on its management. With more included patients than previous studies, this study showed a snDRF prevalence of 19%, congruent with the findings of others. The underlying cause of snDRF is debated, but it cannot solely be explained as an artifact of hydronephrotic kidneys. Further studies on the clinical implications of snDRF are warranted, since DRF influences the decision to operate. CONCLUSION A fifth of all children with suspected UPJO presented with ipsilateral snDRF on initial MAG3 scan, and snDRF was not associated with a greater risk of pyeloplasty. Supported by a large group of international pediatric urology colleagues, this study concludes that the same clinical follow-up and management apply, regardless of presence of snDRF.
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Affiliation(s)
- Sanni Värelä
- Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden; Department of Surgery, Skåne University Hospital, Malmö, Sweden.
| | | | - Eva Persson
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund, Sweden
| | - Anna Börjesson
- Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden; Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden
| | - Lars Hagander
- Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden; Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden
| | - Martin Salö
- Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden; Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden
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Elbaset MA, Ezzat O, Elgamal M, Sharaf MA, Elmeniar AM, Abdelhamid A, Osman Y. Supranormal differential renal function in adults with ureteropelvic junction obstruction: Does it really exist? Indian J Urol 2020; 36:205-211. [PMID: 33082636 PMCID: PMC7531368 DOI: 10.4103/iju.iju_109_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/10/2020] [Accepted: 06/05/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction Some patients with ureteropelvic junction obstruction (UPJO) have supranormal differential renal function (snDRF). We aimed to study the outcomes of pyeloplasty in adult patients with UPJO and either snDRF or normal differential renal function (nDRF) and to identify preoperative factors responsible for the snDRF phenomenon. Materials and Methods We retrospectively retrieved data for all patients who underwent pyeloplasty and had snDRF (differential renal function [DRF] ≥55%) and nDRF (DRF between 45 and 55%) preoperatively. Preoperative radiological data using computed tomography or magnetic resonance imaging were correlated with the presence of snDRF phenomenon. In addition, scintigraphic findings pre- and post-operatively were also assessed to evaluate the functional outcomes. Results Of a total of 856 patients, 31 had snDRF (group 1) and 42 had nDRF (group 2). After a mean of 37 months' follow-up in Group 1, 22 patients developed DRF reduction with non-obstructive pattern. Mean DRF % decreased from 59 ± 2.8 to 48 ± 13 (P < 0.0001). However, in Group 2, five patients had DRF decrease. Four patients developed snDRF phenomenon postoperatively. Increased renal pelvis volume ≥50 mm3 and increased anteroposterior pelvic diameter (APD) ≥37 mm were found to predict snDRF phenomenon. The same findings, in addition to preoperative snDRF, correlated with postoperative DRF decrease. Conclusion SnDRF function could be expected in patients with increased renal pelvis volume and APD. The absolute value or changes in DRF are not reliable to judge treatment failure.
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Affiliation(s)
- M A Elbaset
- Department Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Osama Ezzat
- Department Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Mostafa Elgamal
- Department Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - M A Sharaf
- Department Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - A M Elmeniar
- Department Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Abdalla Abdelhamid
- Department Radiology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Yasser Osman
- Department Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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Yang Q, Wang C, Gao C, Maimaiti W, Li S, Jiang L, Shen M, Shen Y. Does baseline renal function always decrease after unilateral ureteral severe obstruction? -experimental validation and novel findings by Tc-99m diethylene triamine pentaacetate acid (DTPA) dynamic renal scintigraphy. Quant Imaging Med Surg 2019; 9:1451-1465. [PMID: 31559174 DOI: 10.21037/qims.2019.07.09] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background There is a lack of consensus concerning changes in renal function after unilateral ureteral obstruction. The aim of this study was to assess the influence of ureteral obstruction on renal morphology and function and to explore the effectiveness of dynamic renal scintigraphy in evaluating obstructive renal function. Methods We established a model of right ureteral obstruction using New Zealand white rabbits. We measured the glomerular filtration rate (GFR) before the operation and from days 1 to 82 after obstruction, observed the changes in bilateral kidney sizes and the GFR, and then compared the differences between the left and right kidneys. Results The difference between left and right kidney sizes was not significant before obstruction (t=-0.430, P=0.674); the right kidneys increased in size after obstruction and were larger than the left kidneys (P≤0.001). Obstructed kidneys demonstrated a morphological process of decelerated expansion and retraction. The difference in GFR between the left and right kidneys was not significant before obstruction (t=1.77, P=0.098); during days 1-21 and 42-82 after obstruction, the GFR of the right kidneys decreased and was lower than that of the left kidneys (P<0.001); on day 28, the GFR difference between the left and right kidneys (t=1.62, P=0.130) and the difference in the right kidney GFR before and after obstruction (t=1.03, P=0.323) were not significant. The GFR of obstructed kidneys rapidly declined initially, experienced a tortuous process of repeated dormancies and multiple self-recoveries, and then gradually declined. Conclusions The GFR in hydronephrotic kidneys is fluctuating. Thus, evaluating the true function of hydronephrotic kidneys using only baseline GFR is difficult; however, combining baseline GFR with renal morphology to assess obstructive renal function and its recoverability can provide more meaningful results.
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Affiliation(s)
- Qisheng Yang
- Emergency Center, Zhongnan Hospital of Wuhan University, Wuhan 430071, China.,Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Changyin Wang
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Chun Gao
- Second Clinical Faculty, Medical School of Wuhan University, Wuhan 430071, China
| | - Wasili Maimaiti
- Second Clinical Faculty, Medical School of Wuhan University, Wuhan 430071, China
| | - Shun Li
- Second Clinical Faculty, Medical School of Wuhan University, Wuhan 430071, China
| | - Linglong Jiang
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Meijuan Shen
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Ying Shen
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
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The Accuracy of Renal Function Measurements in Obstructive Hydronephrosis Using Dynamic Contrast-Enhanced MR Renography. AJR Am J Roentgenol 2019; 213:859-866. [PMID: 31237781 DOI: 10.2214/ajr.19.21224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE. The objective of our study was to assess the accuracy of glomerular filtration rate (GFR) evaluation in patients with obstructive hydronephrosis using dynamic contrast-enhanced MR renography (DCE-MRR). MATERIALS AND METHODS. A group of 28 adult volunteers were enrolled in this study: 13 without hydronephrosis, eight with low-grade hydronephrosis, and seven with high-grade hydronephrosis. The GFR obtained from DCE-MRR (GFRMRR) and the GFR obtained from renal scintigraphy (GFRRS) were compared with the reference GFR (GFRRef) acquired using the two plasma sample method. The correlation and agreement between GFRMRR and GFRRef, GFRRS and GFRRef, and single-kidney GFRMRR (skGFRMRR) and single-kidney GFRRS (skGFRRS) were assessed. The interrater reliability of DCE-MRR and the interrater reliability of renal scintigraphy (RS) were measured. RESULTS. Both GFRMRR and GFRRS correlated well with GFRRef. In patients with hydronephrosis, DCE-MRR and RS overestimated GFR by 12.8 ± 13.9 mL/min (mean ± SD) and 11.5 ± 12.3 mL/min, respectively. The skGFRRS was higher than skGFRMRR by 5.7 ± 3.8 mL/min in high-grade hydronephrotic kidneys (p = 0.004). Good interrater reliability was observed for skGFRMRR (intraclass correlation coefficient [ICC] = 0.82-0.92) and skGFRRS (ICC = 0.79-0.90) for both nonhydronephrotic kidneys and hydronephrotic kidneys. The overall mean SDs of repeated measurements from three investigators were 4.0 and 3.8 mL/min for skGFRMRR and skGFRRS, respectively. CONCLUSION. Both DCE-MRR and RS tend to overestimate GFR in patients with hydronephrosis. RS-derived skGFR is slightly higher than that of DCE-MRR in kidneys with high-grade hydronephrosis. DCE-MRR is comparable to RS and may serve as an alternative noninvasive method for GFR measurement.
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Martín-Solé O, Soria-Gondek A, Pérez-Bertólez S, Paredes P, Tarrado X, García-Aparicio L. Value of supranormal function on 99m
Tc-mercaptoacetyltriglycine renal scan in paediatric patients with obstructive hydronephrosis. BJU Int 2019; 124:842-848. [DOI: 10.1111/bju.14781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Oriol Martín-Solé
- Department of Pediatric Surgery; Pediatric Urology Division; Hospital Sant Joan de Déu; Universitat de Barcelona; Barcelona Spain
| | - Andrea Soria-Gondek
- Department of Pediatric Surgery; Hospital Germans Trias i Pujol; Universitat Autònoma de Barcelona; Barcelona Spain
| | - Sonia Pérez-Bertólez
- Department of Pediatric Surgery; Pediatric Urology Division; Hospital Sant Joan de Déu; Universitat de Barcelona; Barcelona Spain
| | - Pilar Paredes
- Department of Nuclear Medicine; Hospital Clínic i Provincial de Barcelona; Universitat de Barcelona; Barcelona Spain
| | - Xavier Tarrado
- Department of Pediatric Surgery; Pediatric Urology Division; Hospital Sant Joan de Déu; Universitat de Barcelona; Barcelona Spain
| | - Luis García-Aparicio
- Department of Pediatric Surgery; Pediatric Urology Division; Hospital Sant Joan de Déu; Universitat de Barcelona; Barcelona Spain
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Comparative Outcome Analysis of Children Who Underwent Pyeloplasty for Ureteropelvic Junction Obstruction Associated With or Without Supranormal Differential Renal Function. Urology 2016; 99:210-214. [PMID: 27450350 DOI: 10.1016/j.urology.2016.07.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 07/13/2016] [Accepted: 07/15/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To compare pyeloplasty outcomes in children with and without "supra-normal" differential renal function (SNDRF) defined as >55% differential renal function (DRF) in children with ureteropelvic junction obstruction. METHODS Our prospectively collected pyeloplasty database (2008-2015) was reviewed (n = 151). A total of 140/151 (93%) patients had preoperative renograms and 26/140 (19%) were found to have SNDRF (DRF ≥ 55%). Of 151 patients, 51 (34%) had pre- and postoperative renograms allowing determination of change ≥5% in function. After excluding 2 patients with solitary kidneys, a total of 49 patients defined the study group. RESULTS Of 49 patients, 12 had SNDRF and 37 did not. Baseline characteristics were similar including mean age at surgery (47.3 months vs 45.4 months) and time to surgery (8.7 months vs 9.8 months). Mean preoperative anteroposterior diameter was significantly different between groups (23.2 mm vs 31.0 mm; P = .04), but postoperative was similar (9.0 mm vs 12.1 mm; P = .14). Mean preoperative DRF was 60.2% in the SNDRF group vs 44.3% in the non-SNDRF. Mean postoperative DRF was 52.4% and 45.3%, respectively (P = .04). There were 9/12 (75%) SNDRF patients who experienced ≥5% loss in function compared to 2/37 (5%) in the non-SNDRF group (P < .01). CONCLUSION Three-quarters of SNDRF patients demonstrated a decline of ≥5%DRF postoperatively when compared to non-SNDRF. This finding may not reflect true elevated renal function, but rather hyperfiltration in the setting of obstruction, which-if unrecognized as such-could result in postponing an otherwise beneficial surgical intervention.
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Sanavi C, Dacher JN, Caudron J, Dolores M, Liard A, Vivier PH. Supranormal differential renal function in unilateral hydronephrotic kidney: Insights from functional MR urography. J Magn Reson Imaging 2013; 40:577-82. [DOI: 10.1002/jmri.24440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 08/23/2013] [Indexed: 12/26/2022] Open
Affiliation(s)
- Claire Sanavi
- CHU C. Nicolle; Service d'imagerie pédiatrique et fœtale; Rouen Cedex France
| | - Jean-Nicolas Dacher
- CHU C. Nicolle; Service d'imagerie pédiatrique et fœtale; Rouen Cedex France
- Université de Rouen; INSERM U1096; Rouen Cedex France
| | - Jérome Caudron
- CHU C. Nicolle; Service d'imagerie pédiatrique et fœtale; Rouen Cedex France
- Université de Rouen; INSERM U1096; Rouen Cedex France
| | - Michael Dolores
- CHU C. Nicolle; Service d'imagerie pédiatrique et fœtale; Rouen Cedex France
| | - Agnès Liard
- CHU C. Nicolle; Service de chirurgie pédiatrique; Rouen Cedex France
| | - Pierre-Hugues Vivier
- CHU C. Nicolle; Service d'imagerie pédiatrique et fœtale; Rouen Cedex France
- QuantIF - LITIS [UPRES EA 4108]; Université de Rouen; France
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Klaipetch A, Namwongprom S, Ekmahachai M, Lojanapiwat B. Excretory urography and renal scintigraphy for chronic obstructed kidney: does nonopacity mean nonsalvageability? Singapore Med J 2013; 54:267-70. [PMID: 23716152 DOI: 10.11622/smedj.2013106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION This study aimed to ascertain whether nonopacified kidney on excretory urography (also known as intravenous urography [IVU]) indicates nonsalvageability. METHODS We retrospectively reviewed 45 adult patients with chronic unilateral urinary tract obstruction, in whom IVU revealed nonopacified kidney on one side but normal excretion on the contralateral side. Affected kidneys with split glomerular filtration rate (GFR) < 10 mL/min/1.73 m2 on 99mTc-diethylenetriaminepentaacetic acid diuretic renal scintigraphy were considered nonsalvageable. Non-function was defined based on cutoff points (< 15% and < 20%) to determine the sensitivity and specificity of differential renal function. Differences in IVU and renal scintigraphy findings, with respect to the duration of delayed filming on IVU, were analysed for significance. RESULTS The results of IVU and renal scintigraphy findings for 34 (75.6%) nonopacified kidneys matched, representing nonsalvageable kidneys. Sensitivity and specificity of differential renal function were 76% and 100%, respectively, when the cutoff point for non-function was set at < 15%. Sensitivity and specificity were 97% and 82%, respectively, when the cutoff point was < 20%. There was no significant difference between renal scintigraphy findings and IVU with 2-hour and > 2-hour delayed films (p = 0.96). CONCLUSION Although most nonopacified kidneys on IVU were nonsalvageable, a quarter of them were found to be salvageable on renal scintigraphy. Besides split GFR, differential function at cutoff point < 15% could be used to determine non-function of a chronic obstructed kidney when the contralateral kidney is normal. Delayed filming beyond two hours appears unnecessary in ensuring non-excretion on IVU.
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Affiliation(s)
- Alisa Klaipetch
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
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Cho SY, Kim IS, Lee SB, Choi H, Park K. Nature and fate of supranormal differential renal function: lessons from long-term follow-up after pyeloplasty. Urology 2012. [PMID: 23200971 DOI: 10.1016/j.urology.2012.09.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To understand the nature and long-term fate of supranormal differential renal function (snDRF), analysis of a post-pyeloplasty database was performed. MATERIALS AND METHODS Preoperative diethylenetriaminepentaacetic acid (DTPA) diuretic renal scans (DRS) identified 33 children with snDRF (>55%). Postoperatively, all showed improved hydronephrosis in ultrasound imaging or normalized drainage pattern in DRS during more than 5 years of follow-up. The fate of snDRF was described, and the nature of snDRF was speculated by associating it with clinical and ultrasound-related variables. RESULTS Median age at operation was 22 months. Preoperative hydronephrosis was grade III in 27 patients (82%) and grade IV in 6 (18%). Hydronephrosis was normalized or improved, showing relief of obstruction. Overall fate of snDRF revealed significant reduction of DRF in 23 patients (70%), of whom 18 (81%) showed normalization during 5 years of follow-up. Stationary change of snDRF was seen in one-third of patients. Comparison of clinical and ultrasound-related variables revealed lower age, lower renal parenchyma thickness (RPT) increase, and higher preoperative DRF in the normalized group compared with the other group. The normalized group also showed a higher number in Society of Fetal Urology grade 4 hydronephrosis and lower RPT, although they reached borderline statistical significance. CONCLUSION Long-term follow-up revealed that 70% of snDRF significantly decreased and normalized in most patients. The normalized group was younger and showed more hydronephrotic changes. Hydronephrotic change is suggested as a possible cause of snDRF.
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Affiliation(s)
- Sung Yong Cho
- Department of Urology, Seoul Municipal Boramae Hospital, Seoul, Korea
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11
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Differential renal function estimation by dynamic renal scintigraphy: influence of background definition and radiopharmaceutical. Nucl Med Commun 2008; 29:1002-5. [DOI: 10.1097/mnm.0b013e32830978af] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Pippi Salle JL, Cook A, Papanikolaou F, Bägli D, Breen SL, Charron M, Braga LH, Lorenzo AJ, Khoury AE. The Importance of Obtaining Conjugate Views on Renographic Evaluation of Large Hydronephrotic Kidneys: An In Vitro and Ex Vivo Analysis. J Urol 2008; 180:1559-65. [DOI: 10.1016/j.juro.2008.06.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Indexed: 11/17/2022]
Affiliation(s)
- João Luiz Pippi Salle
- Division of Urology, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | - Anthony Cook
- Alberta Children Hospital, Calgary, Alberta, Canada
| | - Frank Papanikolaou
- Division of Urology, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | - Darius Bägli
- Division of Urology, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | - Stephen L. Breen
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Martin Charron
- Division of Nuclear Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Nuclear Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Luis H.P. Braga
- Division of Urology, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | - Armando J. Lorenzo
- Division of Urology, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | - Antoine E. Khoury
- Division of Urology, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
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MR urography evaluation of obstructive uropathy. Pediatr Radiol 2008; 38 Suppl 1:S49-69. [PMID: 18071689 DOI: 10.1007/s00247-007-0667-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Accepted: 09/26/2007] [Indexed: 10/22/2022]
Abstract
Hydronephrosis and the evaluation of obstructive uropathy are the most common indications for MR urography in our practice. Typically our patients fall into one of two groups: infants with antenatal hydronephrosis and older children who present with abdominal pain, hematuria or urinary tract infection. Obstruction in children is usually chronic and partial. Intermittent episodes of increased pressure occur when the urine production exceeds the capacity for drainage. MR urography uses a fluid and diuretic challenge to assess the hydronephrotic kidney. High-quality anatomic images provide a morphologic assessment of the hydronephrotic system. Although it is relatively straightforward to determine if a system is not obstructed on the basis of the renal transit time (RTT), no single parameter is adequate to fully characterize obstruction. By evaluating the changes in signal intensity in the renal parenchyma following contrast administration, the hydronephrotic systems are classified as compensated or decompensated. Delayed RTT and the presence of urine-contrast levels indicate stasis. Calyceal transit time and the difference between the volumetric and the Patlak differential renal function (vDRF-pDRF) are measures of the physiologic changes within the kidney. Additionally, MR urography provides prognostic information by assessing the quality of the renal parenchyma and identifying uropathy preoperatively. MR urography combines both anatomic and functional information in a single test and is capable of providing a comprehensive evaluation of obstructive uropathy that could ultimately help select those patients most likely to benefit from surgical intervention.
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