Unilateral urinary flow impairment at the pelviureteral junction: outcome of renal function with respect to therapeutic strategy.
OBJECTIVE
To evaluate the renal function outcome in children with unilateral hydronephrosis and urinary flow impairment at the pelviureteral junction with respect to the therapeutic strategy.


METHODS
We retrospectively selected 45 children with iodine-123-hippuran renography performed at diagnosis and after 3 or more years of follow-up. All children had bilateral nonobstructive pattern findings on diuretic renography at follow-up. Eleven children were treated conservatively, and 34 underwent unilateral pyeloplasty. Split and individual renal function, measured by an accumulation index, was computed from background-corrected renograms for the affected and contralateral kidneys at diagnosis and the follow-up examination.


RESULTS
Of 11 children treated conservatively, 9 had normal bilateral function at diagnosis, all had reached normal function at follow-up. Of the 34 operated kidneys, 12 (38%) had initially normal function that remained normal at the follow-up examination, and 22 had impaired function that had normalized at the follow-up examination in 15 (68%). The function of the contralateral kidneys was increased in 5 of 8 children with persistently abnormal affected kidneys. Pyeloplasty was performed in 23 children (68%) and 11 children (32%) younger and older than 1 year, respectively. The function of the affected kidneys increased in both groups, but normalization occurred only in the younger children.


CONCLUSIONS
Of the children selected for conservative treatment, 82% had normal bilateral renal function at diagnosis that was normal in all at the follow-up examination. Of the children treated surgically, 65% had initially impaired function of the affected kidney that improved in 87% after pyeloplasty. Normalization of function was observed only in children who were younger than 1 year old at surgery. Persistently low function of the affected kidney was compensated for by the contralateral one regardless of the age at surgery.
Boubaker
Ariane
A
Department of Nuclear Medicine, University Hospital, Lausanne, Switzerland.
Meyrat
Blaise
B
Frey
Peter
P
Bischof Delaloye
Angelika
A
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D006869:Hydronephrosis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy*; D007223:Infant; D007231:Infant, Newborn; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D007465:Iodohippuric Acid / Q000627:therapeutic use; D007682:Kidney Pelvis / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D008297:Male; D011866:Radioisotope Renography / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography; D014517:Ureteral Obstruction / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*
D007457:Iodine Radioisotopes; D007465:Iodohippuric Acid