Clinical follow-up of children with low differential function on diuretic renogram.
OBJECTIVE
One of the most challenging dilemmas in pediatric urology today is to determine the optimal management of children with hydronephrotic kidney secondary to suspected ureteropelvic junction obstruction. Some believe in early surgical management while others believe in conservative management. To better define these issues, the authors retrospectively reviewed 101 patients with hydronephrosis.


METHODS
The present study was approved by The Children 's Hospital of Philadelphia 's institutional review board and waiver of informed consent for retrospective study. One hundred and one children (72 males and 29 females) of ages of 6 days to 19 years with hydronephrosis with suspected UPJ obstruction underwent diuretic renograms with 99mTc DTPA. The authors classified the differential renal function into three groups: Group I: 0-15%, Group II: 16-30%, and Group III: 31-46%.


RESULTS
Forty-one patients with conservative management, 32% (5 in group I: 1 in group II and 7 in group III) showed improved differential renal function. Non-operative management patients from group I and II showed no deteriorating renal function and only one case from group III had deteriorating renal function. In operative management, 78% of group I, 41% of group II, and 25% of group III showed improvement in differential renal function. In the remaining operative cases, six showed deteriorated differential renal function [1 (4%) group I: 3 (18%) group II: 2 (10%) group III] whereas 24 remained stable or unchanged [Group 1: 4 (17%), Group II: 7 (41%), Group 111: 13 (65%)].


CONCLUSIONS
The authors recommended conservative management for children with differential renal function between 16-46%.
Chotipanich
Chanisa
C
Hospital of the University of Pennsylvania, USA. chanisaja@hotmail.com
Rubin
Joan
J
Lin
Joseph
J
Charron
Martin
M
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004232:Diuretics; D005260:Female; D005665:Furosemide; D006801:Humans; D006869:Hydronephrosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011866:Radioisotope Renography / Q000379:methods*; D012189:Retrospective Studies; D016284:Technetium Tc 99m Pentetate; D014517:Ureteral Obstruction / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy
D004232:Diuretics; D005665:Furosemide; D016284:Technetium Tc 99m Pentetate