Abstract
Purpose
The recognition of those hydronephrotic kidneys which require therapy to preserve renal function remains difficult. We retrospectively compared the ‘tissue tracer transit’ (TTT) of 99mTc-mercaptoacetyltriglycine (99mTc-MAG3) with ‘response to furosemide stimulation’ (RFS) and with ‘single kidney function < 40%’ (SKF < 40%) to predict functional course and thereby need for surgery.
Methods
Fifty patients with suspected unilateral obstruction and normal contralateral kidney had 115 paired (baseline/follow-up) 99mTc-MAG3 scintirenographies. Three predictions of the functional development were derived from each baseline examination: the first based on TTT (visually assessed), the second on RFS and the third on SKF < 40%. Each prediction also considered whether the patient had surgery. Possible predictions were ‘better’, ‘worse’ or ‘stable’ function. A comparison of SKF at baseline and follow-up verified the predictions.
Results
The frequency of correct predictions for functional improvement following surgery was 8 of 10 kidneys with delayed TTT, 9 of 22 kidneys with obstructive RFS and 9 of 21 kidneys with SKF < 40%; for functional deterioration without surgery it was 2 of 3 kidneys with delayed TTT, 3 of 20 kidneys with obstructive RFS and 3 of 23 kidneys with SKF < 40%. Without surgery 67 of 70 kidneys with timely TTT maintained function. Without surgery 0 of 9 kidneys with timely TTT but obstructive RFS and only 1 of 16 kidneys with timely TTT but SKF < 40% lost function.
Conclusion
Delayed TTT appears to identify the need for therapy to preserve function of hydronephrotic kidneys, while timely TTT may exclude risk even in the presence of an obstructive RFS or SKF < 40%.
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References
Kaselas C, Papouis G, Grigoriadis G, Klokkaris A, Kaselas V. Pattern of renal function deterioration as a predictive factor of unilateral ureteropelvic junction obstruction treatment. Eur Urol. 2007;51:551–5.
Chertin B, Pollack A, Koulikov D, Rabinowitz R, Hain D, Hadas-Halpren I, et al. Conservative treatment of ureteropelvic junction obstruction in children with antenatal diagnosis of hydronephrosis: lessons learned after 16 years of follow-up. Eur Urol. 2006;49:734–8.
Murer L, Benetti E, Centi S, Della Vella M, Artifoni L, Capizzi A, et al. Clinical and molecular markers of chronic interstitial nephropathy in congenital unilateral ureteropelvic junction obstruction. J Urol. 2006;176:2668–73.
Koff SA, Binkovitz L, Coley B, Jayanthi VR. Renal pelvis volume during diuresis in children with hydronephrosis: implications for diagnosing obstruction with diuretic renography. J Urol. 2005;174:303–7.
Amarante J, Anderson PJ, Gordon I. Impaired drainage on diuretic renography using half-time or pelvic excretion efficiency is not a sign of obstruction in children with a prenatal diagnosis of unilateral renal pelvic dilatation. J Urol. 2003;169:1828–31.
Zucchetta P, Carasi C, Marzola MC, Murer L, Passerini-Glazel G, Rigamonti W, et al. Angiotensin converting enzyme inhibition worsens the excretory phase of diuretic renography for obstructive hydronephrosis. J Urol. 2001;165:2296–9.
Bajpai M, Puri A, Tripathi M, Maini A. Prognostic significance of captopril renography for managing congenital unilateral hydronephrosis. J Urol. 2002;168:2158–61.
Zaccara A, Marchetti P, la Sala E, Caione P, De Gennaro M. Are preoperative parameters of unilateral pyelo-ureteric junction obstruction in children predictive of postoperative function improvement? Scand J Urol Nephrol. 2000;34:165–8.
Schlotmann A, Clorius JH, Rohrschneider WK, Clorius SN, Amelung F, Becker K. Diuretic renography in hydronephrosis: delayed tissue tracer transit accompanies both functional decline and tissue reorganization. J Nucl Med. 2008;49:1196–203.
O’Reilly P, Aurell M, Britton K, Kletter K, Rosenthal L, Testa T. Consensus on diuresis renography for investigating the dilated upper urinary tract. Radionuclides in Nephrourology Group. Consensus Committee on Diuresis Renography. J Nucl Med. 1996;37:1872–6.
O’Reilly PH. Diuresis renography 8 years later: an update. J Urol. 1986;136:993–9.
Salem YH, Majd M, Rushton HG, Belman AB. Outcome analysis of pediatric pyeloplasty as a function of patient age, presentation and differential renal function. J Urol. 1995;154:1889–93.
Lythgoe MF, Gordon I, Anderson PJ. Effect of renal maturation on the clearance of technetium-99m mercaptoacetyltriglycine. Eur J Nucl Med. 1994;21:1333–7.
Taylor A Jr, Nally JV. Clinical applications of renal scintigraphy. AJR Am J Roentgenol. 1995;164:31–41.
Clorius JH, Reinbold F, Hupp T, Mandelbaum A, Schmidlin P, van Kaick G. Renovascular hypertension: a perfusion disturbance that escaped recognition. J Nucl Med. 1993;34:48–56.
Clorius JH, Mandelbaum A, Hupp T, Reinbold F, Zuna I, Denk S, et al. Exercise activates renal dysfunction in hypertension. Am J Hypertens. 1996;9:653–61.
Hvistendahl JJ, Pedersen TS, Jørgensen HH, Rehling M, Frøkiaer J. Renal hemodynamic response to gradated ureter obstruction in the pig. Nephron 1996;74:168–74.
Frøkiaer J, Pedersen EB, Knudsen L, Djurhuus JC. The impact of total unilateral ureteral obstruction on intrarenal angiotensin II production in the polycalyceal pig kidney. Scand J Urol Nephrol. 1992;26:289–95.
Guyton AC, Hall JE. Urine formation by the kidneys: I. Glomerular filtration, renal blood flow, and their control. In: Textbook of medical physiology. 11th ed. Edinburgh: Elsevier Saunders; 2006. p. 307–26.
Shin GT, Kim WH, Yim H, Kim MS, Kim H. Effects of suppressing intrarenal angiotensinogen on renal transforming growth factor-beta1 expression in acute ureteral obstruction. Kidney Int. 2005;67:897–908.
Gobet R, Park JM, Nguyen HT, Chang B, Cisek LJ, Peters CA. Renal renin-angiotensin system dysregulation caused by partial bladder outlet obstruction in fetal sheep. Kidney Int. 1999;56:1654–61.
Seremetis GM, Maizels M. TGF-beta mRNA expression in the renal pelvis after experimental and clinical ureteropelvic junction obstruction. J Urol. 1996;156:261–6.
Shokeir AA, El-Sherbiny MT, Gad HM, Dawaba M, Hafez AT, Taha MA, et al. Postnatal unilateral pelviureteral junction obstruction: impact of pyeloplasty and conservative management on renal function. Urology 2005;65:980–5.
Gordon I. Diuretic renography in infants with prenatal unilateral hydronephrosis: an explanation for the controversy about poor drainage. BJU Int. 2001;87:551–5.
Koff SA. Postnatal management of antenatal hydronephrosis using an observational approach. Urology 2000;55:609–11.
Eskild-Jensen A, Gordon I, Piepsz A, Frøkiaer J. Congenital unilateral hydronephrosis: a review of the impact of diuretic renography on clinical treatment. J Urol. 2005;173:1471–6.
Josephson S. Antenatally detected, unilateral dilatation of the renal pelvis: a critical review. 1. Postnatal non-operative treatment 20 years on—is it safe? Scand J Urol Nephrol. 2002;36:243–50.
Josephson S. Antenatally detected, unilateral dilatation of the renal pelvis: a critical review. 2. postnatal non-operative treatment—long-term hazards, urgent research. Scand J Urol Nephrol. 2002;36:251–9.
Piepsz A, Ham HR, Erbsmann F, Hall M, Diffey BL, Goggin MJ, et al. A co-operative study on the clinical value of dynamic renal scanning with deconvolution analysis. Br J Radiol. 1982;55:419–33.
Britton KE, Nimmon CC, Whitfield HN, Hendry WF, Wickham JE. Obstructive nephropathy: successful evaluation with radionuclides. Lancet 1979;1:905–7.
Durand E, Blaufox MD, Britton KE, Carlsen O, Cosgriff P, Fine E, et al. International Scientific Committee of Radionuclides in Nephrourology (ISCORN) consensus on renal transit time measurements. Semin Nucl Med. 2008;38:82–102.
Verboven M, Achten R, Keuppens F, Jonckheer M, Piepsz A. Radioisotopic transit parameters in obstruction of pelviureteral junction. Urology 1988;32:370–4.
Vivian GC, Barratt TM, Todd-Pokropek A, Gordon I. Renal parenchymal determination and analysis during dynamic 99Tcm-DTPA scans in children. Nucl Med Commun. 1984;5:35–40.
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An editorial commentary on this paper is available at http://dx.doi.org/10.1007/s00259-009-1160-7.
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Schlotmann, A., Clorius, J.H. & Clorius, S.N. Diuretic renography in hydronephrosis: renal tissue tracer transit predicts functional course and thereby need for surgery. Eur J Nucl Med Mol Imaging 36, 1665–1673 (2009). https://doi.org/10.1007/s00259-009-1138-5
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DOI: https://doi.org/10.1007/s00259-009-1138-5