Decreased percent change in renal pelvis diameter on diuretic functional magnetic resonance urography following administration of furosemide may help characterize unilateral uretero-pelvic junction obstruction

Abstract

A well-established definition of obstruction in the setting of congenital hydronephrosis is lacking. Multiple imaging modalities and radiographic characteristics or parameters have been described to help confirm the diagnosis of ureteropelvic junction obstruction (UPJO). We sought to evaluate the change in anterior-posterior renal pelvic diameter (APRPD) following furosemide administration in patients with unilateral hydronephrosis and confirmed UPJO on functional magnetic resonance urography (fMRU) who underwent pyeloplasty. There were 49 patients who met inclusion criteria (11 females, 38 males; average age 2.2 years, SD 3.4 years) from February 2006 to September 2020, diagnosed with unilateral hydronephrosis (SFU Grade 3-4) who underwent fMRU prior to pyeloplasty for confirmed UPJO. 29 of the included patients also underwent a post-pyeloplasty fMRU. A weight-adjusted dose of 1mg/kg of furosemide (max 20mg/kg) was administered intravenously. Two board-certified pediatric radiologists measured the APRPD of the obstructed and non-dilated kidneys prior to pyeloplasty and APRPD of the hydronephrotic kidneys on the post-pyeloplasty follow up fMRUs. Measurements were performed on images prior to and approximately 30min following furosemide injection. The average APRPD before furosemide injection in the obstructed kidney prior to pyeloplasty was 26.3mm (SD 9.0mm) compared to the non-dilated (not obstructed) kidney measurement of 5.1mm (SD 3.6mm) (p<0.001). Following administration of furosemide, the average APRPD was 31.4mm (SD 8.8mm) in the obstructed kidney, and 7.8mm (SD 4.1mm) in the non-dilated kidney (p<0.001). After pyeloplasty, the pre-furosemide APRPD measurement was 17.8mm (SD 11mm), which was significantly less compared to the pre-pyeloplasty APRPD (p<0.001). The post-pyeloplasty, post-furosemide APRPD measurement was 25.8mm (SD 12mm), also significantly less compared to the pre-pyeloplasty measurement (p=0.02). The changes in APRPD in the obstructed kidney prior to pyeloplasty was 5.1mm (SD 3.5mm) and after pyeloplasty was 8mm (SD 4.6mm) (p=0.002). Change in APRPD in the non-dilated kidney was 2.7mm (SD 2.3mm). Percent APRPD change in the obstructed kidney was 22.9% (SD 18.5%), which was significantly less than 33.3% (SD 22.1%) in the post-pyeloplasty kidney (p=0.028) and 82.8% (SD 87.9%) in the non-dilated kidney (p<0.001). A relatively smaller change in APRPD on fMRU following administration of furosemide in the setting of UPJO may serve as another predictive characteristic of obstructed kidneys.