PD15-02 FUROSEMIDE-INDUCED CHANGES IN RENAL PELVIS ANTEROPOSTERIOR DIAMETER MEASURED WITH POINT OF CARE ULTRASOUND: PILOT STUDY OF A RADIATION-FREE STRATEGY TO DETECT OBSTRUCTION IN THE PEDIATRIC UROLOGY CLINIC

Abstract

You have accessJournal of UrologyPediatric Urology I (PD15)1 Sep 2021PD15-02 FUROSEMIDE-INDUCED CHANGES IN RENAL PELVIS ANTEROPOSTERIOR DIAMETER MEASURED WITH POINT OF CARE ULTRASOUND: PILOT STUDY OF A RADIATION-FREE STRATEGY TO DETECT OBSTRUCTION IN THE PEDIATRIC UROLOGY CLINIC Jin Kyu Kim, Marisol Lolas, Michael Chua, Daniel T. Keefe, Joana Dos Santos, Armando J. Lorenzo, and Mandy Rickard Jin Kyu KimJin Kyu Kim More articles by this author , Marisol LolasMarisol Lolas More articles by this author , Michael ChuaMichael Chua More articles by this author , Daniel T. KeefeDaniel T. Keefe More articles by this author , Joana Dos SantosJoana Dos Santos More articles by this author , Armando J. LorenzoArmando J. Lorenzo More articles by this author , and Mandy RickardMandy Rickard More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001997.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Point of care ultrasound (POCUS) is an increasingly utilized resource that allows providers to obtain real-time imaging for clinical decision making. Hydronephrosis (HN) is a common condition seen in pediatric urology clinics, often assessed with serial ultrasounds (US) and Mercaptoacetyltriglycine (MAG3) furosemide nuclear studies. We hypothesized that for patients with obstruction, the anteroposterior diameter (APD) would increase post-furosemide administration, which can be identified with POCUS. METHODS: From June 2020 - Feb 2021, selected patients being evaluated for HN underwent a same-day standardized imaging sequence: pre-furosemide kidney/bladder US, MAG3 renogram, and post-furosemide in-clinic kidney/bladder POCUS. Variables captured included: pre-furosemide APD, T1/2 time and differential function, post-furosemide POCUS APD, and time from furosemide injection to POCUS. To account for anatomical and physiological effects of renal pelvis dilation, an index was created to represent the change in renal pelvis based on pre-APD and time to POCUS. To accomplish this, we performed a logarithmic Yeo-Johnson power transformation to the proportional change in APD of hydronephrotic kidney from pre-US to POCUS, adjusting for the time from furosemide injection to POCUS. Patients were divided into group 1: those who had a T1/2 < 20 mins, group 2: T1/2 > 20 mins, and group 3: no observable drainage. A correlation was drawn between T1/2 of the obstructed kidney and our index variable. RESULTS: 43 renal units were included in the analysis (7 group 1, 20 group 2, 16 group 3). There was a significant correlation between T1/2 of group 2 and our index variable(R=0.588, p=0.006, Figure 1). This correlation was not observed in group 1 patients(R=0.097, p=0.836) or group 3 patients (R=-0.261, p=0.329). CONCLUSIONS: This proof of concept investigation demonstrates that changes from pre-furosemide APD to post-furosemide APD may have value in estimating the degree of obstruction in patients with HN, particularly those who are in the “equivocal” range of T1/2 time. Further assessment may allow providers to determine the presence and degree of obstruction without the need to expose the child to a radiotracer. Source of Funding: NA © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e272-e272 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jin Kyu Kim More articles by this author Marisol Lolas More articles by this author Michael Chua More articles by this author Daniel T. Keefe More articles by this author Joana Dos Santos More articles by this author Armando J. Lorenzo More articles by this author Mandy Rickard More articles by this author Expand All Advertisement Loading ...