title: Comparison Between Diuretic Urography (IVP) and Diuretic Renography for Diagnosis of Ureteropelvic Junction Obstruction in Children.
abstract: BACKGROUND
  Ureteropelvic junction obstruction (UPJO) is one of the most common causes of urinary tract obstruction in children. Several methods are used to diagnose upper urinary tract obstruction including renal ultrasonography (US), intravenous pyelogram (IVP), diuretic renography (DR), magnetic resonance urography (MRU) and antegrade or retrograde pyelography. Nowadays it is suggested to use diuretic renography as the best method for diagnosing of UPJO. There is no comparative study between IVP and DR scan for diagnosis of UPJO in children.
  
  
  OBJECTIVE
  The aim of the present study was to compare IVP with furosemide injection and diuretic renography in diagnosis of clinically significant UPJO.
  
  
  METHODS
  This was a cross sectional study performed in 153 UPJO suspected children (121 boys, 32 girls) based on US findings in cases presented with urinary tract infection (UTI), prenatal hydronephrosis, abdominal/flank pain, abdominal mass and hematuria. Renal ultrasound was used as an initial screening tool for detection of urinary tract abnormality. Vesicoureteral reflux (VUR) was ruled out by voiding cystourethrography (VCUG). Serum creatinin, blood urea nitrogen, urinalysis and urine culture was screened in all cases. IVP with furosemide and DR were performed as soon as possible after the mentioned workup.
  
  
  RESULTS
  During a five year period, 46 out of 153 patients were diagnosed as UPJO based on diuretic renography: the age ranged from 4 months to 13 years (mean: 3.1 ± 0.78 years). There was a significant higher (76%) proportion of UPJO in the boys and in the left side (78%). The sensitivity of IVP with furosemide injection in diagnosis of UPJO was 91.3% whereas DR was accepted as standard for diagnostic procedure in diagnosis of UPJO.
  
  
  CONCLUSIONS
  Although DR is accepted as the best method for diagnosis of UPJO, we found a small sensitivity difference between IVP and DR in kidneys with normal or near normal function. In many settings such as small cities lacking facilities for advanced isotope imaging technology, use of IVP with diuretic maybe an acceptable procedure for diagnosis of UPJO.
authors: Pediatric Nephrology Department, Ghaem Medical Center, Mashhad, IR Iran.
authors: Mohammad
authors: M
authors: Esmaeili
authors: Department of Pediatrics, Iran University of Medical Sciences, Tehran, IR Iran.
authors: Marjan
authors: M
authors: Esmaeili
authors: Pediatric Nephrology Department, Ghaem Medical Center, Mashhad, IR Iran.
authors: Fatemeh
authors: F
authors: Ghane
authors: Department of Radiology, Dr. Sheikh Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran.
authors: Ali
authors: A
authors: Alamdaran
keywords: Children; Diruretic Urography; Diuretic Renography; Excretory Urography; Intravenous Urography; Ureteropelvic Junction Obstruction