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Volume Expanded Diuretic Renography in the Postnatal Assessment of Suspected Uretero-Pelvic Junction Obstruction

Departments of Nuclear Medicine and Ultrasound, Paediatrics and Paediatric Surgery, Westmead Hospital, Sydney, Australia

Correspondence: For reprints contact: Simon M. Gruenewald, FRACP, Department of Nuclear Medicine and Ultrasound, Westmead Hospital, Westmead, NSW 2145, Australia.

ABSTRACT

Controversy surrounds the role of ^99mTc-diethylenetriamine pentaacetic acid renography in suspected uretero-pelvic junction obstruction in early life. Accordingly, we retrospectively reviewed 18 patients (28 hydronephrotic kidneys) with a mean age of 2 mo (range: 1 wk–6 mo) who underwent a total of 36 scans using intravenous volume expansion (10 ml/kg) and furosemide diuresis (1 mg/kg). Initial scans were classified as obstructed, not obstructed or in determinate using differential renal function, furosemide washout T and visual assessment of tracer clearance. Those initially classified as obstructed (n = 8) have been surgically confirmed. In the indeterminate (n = 6) and nonobstructed (n = 1 4) groups, three and two kidneys, respectively, developed obstruction on progress scans. Mean follow-up in the nonsurgical patients was approximately 9 mo (range: 4–17 mo). A total of 13 kidneys had developed obstruction by renographic criteria, and to date12 have surgical confirmation. Our data indicate that: (1) scans classified as obstructed correlate well with surgery; (2) an initial classification of indeterminate or non obstructed does not exclude later development of obstruction; and (3) serial scans correctly stratify children with possible uretero-pelvic junction obstruction.

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