[Diagnostic comparison of diuretic isotopic renogram and diuretic Doppler ultrasonography in pediatric hydronephrosis].
Due to the high frequency of asymptomatic pyelocaliceal dilatations, most of them with prenatal diagnosis, the diagnosis of obstruction remains a major chance. Isotopic diuretic renogram (IDR) remains the basic diagnostic tool, although it has some pitfalls and undetermined diagnosis. To obviate them, several others tests have been used, such as diuretic Doppler ultrasound (DDU). The object of this paper is to determine its validity.


METHODS
All the patients with hydronephrosis and with grade II dilatation or bigger were studied wit DDU. The results were compared with those obtained by IDR, obtaining 2 x 2 tables to analyze specificity and sensibility.


RESULTS
37 patients were studied, 9 of them bilateral, with a total of 46 dilated kidneys. There were 22 males and 15 females. 59 percent had prenatal diagnosis and 57 percent were asymptomatic. 22 percent had grade IV dilatation, 37 percent grade III and 41 percent grade II. 2 cases had contralateral vesicoureteral reflux. IDR showed 15 obstructed kidneys, 7 of them with a regular renal function. 16 were operated, one more due to abdominal pain despite a non-obstructed IDR. Only 7 of the 15 kidneys presented an obstructive pattern in the DDU. Comparing both tests, DDU had a 46 percent of sensibility and 100 percent of specificity and a negative predictive value of 79% for a 95% interval. Kramer index was 0.54 representing a very low association.


CONCLUSIONS
In our institution, DDU is not better than IDR to diagnose obstruction. We consider its use as a second line test in cases of doubtful IDR.
Gómez Fraile
A
A
Sección de Urología Pediátrica, Hospital Universitario 12 de Octubre, Madrid.
Aransay Bramtot
A
A
Miralles
M
M
López Vázquez
F
F
García Luzón
A
A
Jiménez Isabel
A
A
D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D004232:Diuretics; D005069:Evaluation Studies as Topic; D005665:Furosemide; D006801:Humans; D006869:Hydronephrosis / Q000175:diagnosis* / Q000000981:diagnostic imaging; D007223:Infant; D007231:Infant, Newborn; D008962:Models, Theoretical; D011237:Predictive Value of Tests; D011866:Radioisotope Renography; D012680:Sensitivity and Specificity; D018608:Ultrasonography, Doppler
D004232:Diuretics; D005665:Furosemide