Volume expanded diuretic renography in the postnatal assessment of suspected uretero-pelvic junction obstruction.
Controversy surrounds the role of 99mTc-diethylenetriamine pentaacetic acid renography in suspected uretero-pelvic junction obstruction in early life. Accordingly, we retrospectively reviewed 18 patients (28 hydronephrotic kidneys) with a mean age of 2 mo (range: 1 wk-6 mo) who underwent a total of 36 scans using intravenous volume expansion (10 ml/kg) and furosemide diuresis (1 mg/kg). Initial scans were classified as obstructed, not obstructed or indeterminate using differential renal function, furosemide washout T 1/2 and visual assessment of tracer clearance. Those initially classified as obstructed (n = 8) have been surgically confirmed. In the indeterminate (n = 6) and nonobstructed (n = 14) groups, three and two kidneys, respectively, developed obstruction on progress scans. Mean follow-up in the nonsurgical patients was approximately 9 mo (range: 4-17 mo). A total of 13 kidneys had developed obstruction by renographic criteria, and to date 12 have surgical confirmation. Our data indicate that: (1) scans classified as obstructed correlate well with surgery; (2) an initial classification of indeterminate or nonobstructed does not exclude later development of obstruction; and (3) serial scans correctly stratify children with possible uretero-pelvic junction obstruction.
Choong
K K
KK
Department of Nuclear Medicine, Westmead Hospital, Sydney, Australia.
Gruenewald
S M
SM
Hodson
E M
EM
Antico
V F
VF
Farlow
D C
DC
Cohen
R C
RC
D005260:Female; D005665:Furosemide; D006801:Humans; D006869:Hydronephrosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D007223:Infant; D007231:Infant, Newborn; D007682:Kidney Pelvis; D008297:Male; D011866:Radioisotope Renography / Q000379:methods*; D012189:Retrospective Studies; D014517:Ureteral Obstruction / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology
D005665:Furosemide