Clinical follow-up of children with low differential function on diuretic renogram

Chotipanich, C.; Rubin, J.; Lin, J.; Charron, M.

Journal of the Medical Association of Thailand 90(4): 754-761


ISSN/ISBN: 0125-2208
PMID: 17487132
Document Number: 2821
Objective: One of the most challenging dilemmas in pediatric urology today is to determine the optimal management of children with hydronephrotic kidney secondary to suspected ureteropelvic junction obstruction. Some believe in early surgical management while others believe in conservative management. To better define these issues, the authors retrospectively reviewed 101 patients with hydronephrosis.Material and Method: The present study was approved by The Children Hospital of Philadelphia,'y institutional review board and waiver of informed consent for retrospective study. One hundred and one children (72 males and 29 females) of ages of 6 days to 19 years with hydronephrosis with suspected UPJ obstruction underwent diuretic renograms with Tc-99m DTPA. The authors classified the differential renal function into three groups: Group I: 0- 15%, Group IL 16-30%, and Group 111: 31-46%.Results: Forty-one patients with conservative management, 32% (5 in group I: I in group II and 7 in group III) showed improved differential renal function. Non-operative management patients from group I and H showed no deteriorating renal function and only one case from group III had deteriorating renal function. In operative management, 78% ofgroup 1, 41 % ofgroup II, and 25% ofgroup III showed improvement in differential renal function. In the remaining operative cases, six showed deteriorated differential renal function [I (4%) group I: 3(18Yo) group II: 2 (10%) group III] whereas 24 remained stable or unchanged [Group I: 4(17%), Group II: 7(41%), Group III: 13 (65%)].Conclusion: The authors recommended conservative management for children with differential renal function between 16-46%.

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Clinical follow-up of children with low differential function on diuretic renogram