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Clinical Investigations |
Departments of Nuclear Medicine and Paediatric Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
We studied the response to F+0 renography and the relative and absolute individual kidney function in neonates and <6-mo-old infants before and after surgery for unilateral ureteropelvic junction obstruction (UJO). Methods: The results obtained at diagnosis and after pyeloplasty for 9 children (8 boys, 1 girl; age range, 0.8–5.9 mo; mean age ± SD, 2.4 ± 1.5 mo) with proven unilateral UJO (i.e., affected kidney [AK]) and an unremarkable contralateral kidney (i.e., normal kidney [NK]) were evaluated and compared with a control group of 10 children (6 boys, 4 girls; age range, 0.8–2.8 mo; mean age, 1.5 ± 0.7 mo) selected because of symmetric renal function, absence of vesicoureteral reflux or infection, and an initially dilated but not obstructed renal pelvis as proven by follow-up. Renography was performed for 20 min after injection of 123I-hippuran (OIH) (0.5–1.0 MBq/kg) immediately followed by furosemide (1 mg/kg). The relative and absolute renal functions and the response to furosemide were measured on background-subtracted and depth-corrected renograms. The response to furosemide was quantified by an elimination index (EI), defined as the ratio of the 3- to 20-min activities: An EI 
3 was considered definitively normal and an EI 
1 definitively abnormal. If EI was equivocal (1 < EI < 3), the response to gravity-assisted drainage was used to differentiate AKs from NKs. Absolute separate renal function was measured by an accumulation index (AI), defined as the percentage of 123I-OIH (%ID) extracted by the kidney 30–90 s after maximal cardiac activity. Results: All AKs had definitively abnormal EIs at diagnosis (mean, 0.56 ± 0.12) and were significantly lower than the EIs of the NKs (mean, 3.24 ± 1.88) and of the 20 control kidneys (mean, 3.81 ± 1.97; P < 0.001). The EIs of the AKs significantly improved (mean, 2.81 ± 0.64; P < 0.05) after pyeloplasty. At diagnosis, the AIs of the AKs were significantly lower (mean, 6.31 ± 2.33 %ID) than the AIs of the NKs (mean, 9.43 ± 1.12 %ID) and of the control kidneys (mean, 9.05 ± 1.17 %ID; P < 0.05). The AIs of the AKs increased at follow-up (mean, 7.81 ± 2.23 %ID) but remained lower than those of the NKs (mean, 10.75 ± 1.35 %ID; P < 0.05). Conclusion: In neonates and infants younger than 6 mo, 123I-OIH renography with early furosemide injection (F+0) allowed us to reliably diagnose AKs and to determine if parenchymal function was normal or impaired and if it improved after surgery.
Key Words: diuretic renography • hydronephrosis • neonate • function recovery
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