title: Can severely impaired cortical transit predict which children with pelvi-ureteric junction stenosis detected antenatally might benefit from pyeloplasty?
abstract: BACKGROUND
  Until recently, renogram, performed in children with pelvi-ureteric junction stenosis detected antenatally, has not been able to predict the probability of function improvement after surgery or the risk of function deterioration in case of conservative attitude. Recently, Schlotmann et al. have suggested that cortical transit might have this predictive role. The aim of this study, focused on those kidneys with severely impaired cortical transit, was to verify this statement.
  
  
  METHODS
  All renograms performed in children during a 3-year period (n=729) were retrospectively reviewed and 19 pediatric patients were selected based on an antenatally detected unilateral pelvi-ureteric junction syndrome, the existence of at least two renograms during the follow-up and a severe cortical transit impairment, visually defined. Twenty-six pairs of data could be analyzed and allowed comparing preoperative and postoperative differential renal function (DRF), and the DRF changes during the conservative management.
  
  
  RESULTS
  Among the 16 patients who underwent pyeloplasty, 10 showed a significant DRF improvement. Among the 10 patients with conservative follow-up, four showed a significant DRF deterioration.
  
  
  CONCLUSIONS
  Severely impaired cortical transit seems to be a valuable marker of those patients who could benefit from a pyeloplasty, either because of the high probability of postoperative DRF improvement, or because of DRF deterioration in case of an conservative approach. However, a normal cortical transit, as defined in this study, does not exclude the risk of DRF deterioration. Alternatively, the design of this study does not allow excluding the fact that DRF might improve after pyeloplasty despite a normal cortical transit.
authors.affiliation: Department of Radioisotopes, University Hospital St Pierre, Brussels, Belgium. amypiepsz@yahoo.com
authors.forename: Amy
authors.initials: A
authors.lastname: Piepsz
authors.forename: Marianne
authors.initials: M
authors.lastname: Tondeur
authors.forename: Cécile
authors.initials: C
authors.lastname: Nogarède
authors.forename: Frank
authors.initials: F
authors.lastname: Collier
authors.forename: Khalid
authors.initials: K
authors.lastname: Ismaili
authors.forename: Michelle
authors.initials: M
authors.lastname: Hall
authors.forename: André
authors.initials: A
authors.lastname: Dobbeleir
authors.forename: Hamphrey
authors.initials: H
authors.lastname: Ham
mesh_terms: D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D007672:Kidney Cortex / Q000000981:diagnostic imaging / Q000503:physiopathology*; D007682:Kidney Pelvis / Q000000981:diagnostic imaging / Q000601:surgery*; D011247:Pregnancy; D011296:Prenatal Diagnosis; D011866:Radioisotope Renography; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D014513:Ureter / Q000601:surgery*