ESPN 51th Annual Meeting

ESPN 2018


 
Diuretic renography in hydronephrosis: A retrospective single-center study
YASAR KANDUR 1 AHMET SALAN 2 AHMET GOKHAN GULER 3 FATIH TUTEN 4

1- DEPARTMENT OF PEDIATRIC NEPHROLOGY, NECIP FAZIL CITY HOSPITAL, KAHRAMANMARAS, TURKEY
2- DEPARTMENT OF NUCLEAR MEDICINE, NECIP FAZIL CITY HOSPITAL, KAHRAMANMARAS, TURKEY
3- DEPARTMENT OF PEDIATRIC SURGERY, FACULTY OF MEDICINE, SUTCU IMAM UNIVERSITY, KAHRAMANMARAS, TURKEY
4- DEPARTMENT OF RADIOLOGY, NECIP FAZIL CITY HOSPITAL, KAHRAMANMARAS, TURKEY
 
Introduction:

The aim of our study is to examine whether anteroposterior pelvic diameter on renal ultrasound (US) scan  can predict both differential renal function(DFR) and obstruction in pediatric patients, and whether an US adequately identifies those patients who need further investigation. We also aimed to design a study with a larger sample size than previous studies investigating the relationship between MAG3 and  US. 

Material and methods:

 We retrospectively reviewed the MAG3, US, dimercaptosuccinic acid scan (DMSA) findings, and medical records of pediatric patients with hydronephrosis and/or atrophy who were at follow-up between January 2013 and December 2016 in our center which is located in the south-east region of Turkey

Results:

 Two hundred and twenty-five pediatric patients (M/F = 156/69) with unilateral hydronephrosis but without VUR were enrolled in this study. The mean age of the children was 45.4 ± 48.3 months (range 2 - 173 months). Sixty-nine patients had obstructive pattern on 99mTc-MAG3.  An APD of greater than 20 mm had a 15.8-times (95 % CI 5.72–43.69)  higher likelihood of having obstruction MAG3 findings .On the other hand, an APD of greater than 15 cm had 9.2 times (95 % CI 3.01–28.57) higher likelihood of having obstruction MAG3 findings.The regression analysis showed that an APD of greater than 20mm was a risk factor for low DRF (OR=5.208, 95% CI: 1.529-17.743, p=0.008). However, the regression analysis showed that an APD of greater than 15 mm was not a risk factor low DRF. 

Conclusions:

 The combination of ultrasound and MAG3 provides the necessary anatomical and functional information to follow the degree of obstruction and to decide between surgical intervention and conservative follow-up. Our study supports a threshold of 20 mm rather than 15 mm for severe obstruction and a low DRF. An APD threshold greater than 15 mm had not a predictive value in DRF estimation.