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F+0 Renography in Neonates and Infants Younger Than 6 Months: An Accurate Method to Diagnose Severe Obstructive Uropathy

Departments of Nuclear Medicine and Paediatric Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

View larger version (78K): [in a new window]   FIGURE 1. Diuretic (F+0) renography was performed on 1.4-mo-old boy in whom bilateral pelvic dilatation detected during pregnancy persisted on left side on postnatal sonograms. (A) One-minute posterior views show symmetric kidneys and rapid, symmetric urinary excretion. (B) Two-minute posterior views obtained 20 min after injection (left) and after prone positioning (right) show no significant urinary flow restriction. (C) Regions of interest and time–activity curve (heart, dark line; bladder, dotted line). Bladder curve shows rapidly increasing activity and micturition. (D) Background-corrected renograms (left kidney, dotted line; right kidney, dark line) show symmetric early 123I-OIH renal uptake (accumulation index: left, 8.39 %ID; right, 9.82 %ID) and normal symmetric response to early furosemide injection (elimination index: left, 4.61; right, 6.26).

View larger version (63K): [in a new window]   FIGURE 2. Diuretic renography was performed on 2.5-mo-old boy in whom grade 2 hydronephrosis on left side was diagnosed during pregnancy and confirmed after birth. (A) One-minute posterior views at diagnosis show parenchymal thinning of left kidney and no response to furosemide, whereas right kidney appears normal. (B) Same views obtained at follow-up show persistent left parenchymal thinning and improvement in left urinary flow under furosemide. (C) Background-corrected renal curves (left kidney, dark line; right kidney, dotted line) at diagnosis show decreased tracer uptake by left kidney (AI, 6.50 %ID) and typical obstructive curve pattern (EI, 0.66). Contralateral kidney was normal (AI, 8.94 %ID; EI, 4.35). (D) After surgery, left kidney improved in function and drainage (AI, 9.43 %ID; EI, 2.15) and right kidney remained normal (AI, 9.40 %ID; EI, 6.43).

View larger version (13K): [in a new window]   FIGURE 3. EIs of AKs, contralateral NKs, and control kidneys at diagnosis and of AKs and NKs at follow-up. *P < 0.05; **P < 0.001.

View larger version (17K): [in a new window]   FIGURE 4. AIs of AKs (A) and contralateral NKs (B) before and after surgery.

View larger version (14K): [in a new window]   FIGURE 5. Relative function of AKs before and after surgery.

View larger version (16K): [in a new window]   FIGURE 6. AIs of AKs, contralateral NKs, and control kidneys at diagnosis and of AKs and NKs at follow-up. *P < 0.05.