Delayed renal tissue tracer transit in Tc-99m-DTPA renography correlates with postoperative renal function improvement in UPJO patients.
OBJECTIVE
The aim of the study was to explore the potential parameters for evaluating the improvement in relative renal function (RRF) in patients with unilateral ureteropelvic junction obstruction (UPJO) who underwent surgery. In this regard we observed the RRF expressed as the obstructed kidney's percentage contribution to overall renal function in technetium-99m diethylenetriaminepentaacetic acid (Tc-99m-DTPA) diuretic renography.


METHODS
Data on 47 patients, who underwent Anderson-Hynes pyeloplasty for diagnosed unilateral UPJO during the period of February 2003 to October 2014, were retrospectively collected. Tc-99m-DTPA diuretic renography was performed on all patients before and after surgery, and no morphological or functional abnormalities were detected on the contralateral kidney. Several parameters, especially renal tissue tracer transit (TTT), the response to furosemide stimulation, and RRF, were evaluated. All data were analyzed with the statistical software SPSS, 17.0, and a value of P less than 0.05 was considered statistically significant.


RESULTS
Data on 42 patients were eventually retained for further analysis; five patients were excluded because of indeterminate TTT. All patients showed obstructive response to furosemide stimulation with a preoperative RRF of 41±12%. Postoperative RRF of the obstructed kidneys was 47±11%, significantly higher than the preoperative RRF (P<0.05). Postoperative RRF improvement (absolute increment≥5%) was seen in 18/42 (43%) patients, and 24/42 (57%) of them manifested with postoperative drainage improvement. After surgery, both the RRF increment and the percentage of patients with postoperative RRF improvement in the preoperative delayed TTT group were significantly higher than those in the normal TTT group (12±7 vs. 2±4%, and 81 vs. 19%, respectively; P<0.05), but no significant difference in postoperative drainage improvement was detected between the two groups (56 vs. 54%, P>0.05). None of the other factors, including the preoperative RRF, obstructed kidney location, surgical method, sex, and age, had a significant influence on postoperative RRF improvement (P>0.05).


CONCLUSIONS
Preoperatively delayed TTT of Tc-99m-DTPA diuretic renography was an independent factor that correlated with RRF improvement of unilaterally hydronephrotic kidneys, and might provide valuable information for surgical decisions pertaining to UPJO patients.
Departments of aNuclear Medicine bUltrasound, Peking University First Hospital, Beijing, China.
Meng
M
Liu
Zhanli
Z
Fu
Qian
Q
Li
Lijuan
L
Di
Jianhua
J
Zhang
Yan
Y
Fan
Xuchu
X
Zhang
Rongfu
R
Wang
D000293:Adolescent; D000328:Adult; D001692:Biological Transport; D005260:Female; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011379:Prognosis; D011849:Radioactive Tracers; D011866:Radioisotope Renography; D020127:Recovery of Function; D012189:Retrospective Studies; D016284:Technetium Tc 99m Pentetate / Q000378:metabolism*; D014517:Ureteral Obstruction / Q000000981:diagnostic imaging / Q000378:metabolism / Q000503:physiopathology* / Q000601:surgery*; D055815:Young Adult
D011849:Radioactive Tracers; D016284:Technetium Tc 99m Pentetate