Diethylenetriaminepentaacetic Acid Renal Scan Research Articles

Glomerular Filtration Rate Estimation With Commonly Used Methods Among Healthy Live Kidney Donors of South Punjab, Pakistan.

BackgroundAccurate estimation of the donor’s glomerular filtration rate (GFR) is crucial for not only ensuring the medical appropriateness of the donor but also for the prediction of future allograft performance. The aim of this study was to compare the GFR estimation formulas and 24-hour urine creatinine clearance with diethylene triamine pentaacetic acid (DTPA) renal scan GFR.MethodsThis cross-sectional study was done at the Department of Nephro Urology Dialysis & Renal Transplantation, Bahawal Victoria Hospital, Quaid e Azam Medical College, Bahawalpur, Pakistan from September 2018 to September 2021. A total of 92 potential healthy live-related kidney donors of both genders, aged 18 to 60 years having body mass index below 35 kg/m2 were included. GFR was calculated with modification of diet in renal disease (MDRD), Cockcroft-Gault (CG), chronic kidney disease epidemiology (CKD-EPI) equations as well as by 24-hour urine creatinine clearance. DTPA renal scan was done to record GFR findings. GFR was compared using analysis of variance (ANOVA) among different methods.ResultsOut of a total of 92 individuals, 49 (53.3%) were male and 43 (46.7%) female. Mean age and BMI were noted to be 34.62±10.57 years and 24.40±2.71 kg/m2, respectively. Statistically significant differences existed between various methods of GFR estimation (p<0.001). Mean GFR as per DTPA renal scan findings was noted to be 97.32±9.39 ml/min/1.73 m2. Difference of 31.48±20.81, 27.37±21.1, 23.38±6.38, 15.52±37.52 was noted in estimated GFR (ml/min/1.73 m2) with CG formula, MDRD formula, EPI-CKD formula and 24-hour urine creatinine clearance respectively when compared with DTPA renal scan findings. The highest proportion of patients was seen with normal GFR with DTPA renal scan findings as 83 (90.2%) individuals while 24-hour urine creatinine clearance observed these to be 59 (64.1%), CG EPI-CKD formula 44 (47.8%), MDRD formula 39 (42.4%) and 40 (43.5%) with CG formula.ConclusionNone of the GFR estimation methods resulted in similar findings. With reference to the DTPA renal scan, 24-hour urine creatinine clearance was the closest GFR estimation followed by CKD-EPI and MDRD equations.

Deceased vs. living donor kidney transplantation in prediction of acute renal allograft rejection using Tc-99m DTPA renal scan

No data are available regarding different prognostic values of Tc-99m diethylenetriaminepentaacetic acid (DTPA) renal scan in kidney transplantation (KT) recipients according to two distinct donor types: deceased donor KT (DDKT) and living donor KT (LDKT). We evaluated whether the interpretation of Tc-99m DTPA renal scan should be different by the donor type in predicting acute renal allograft rejection (AR). One hundred and seven KT recipients (61 DDKT and 46 LDKT) were included in this study. Tc-99m DTPA renal scan was performed 1week after KT. AR was defined as pathological evidence of renal allograft rejection during the first 6months of KT. Clinical factors and Tc-99m DTPA renal scan findings were compared between patients with and without AR. To further analyze the effect of the donor type, they were again compared within DDKT and LDKT recipients, respectively. AR occurred in 15 patients (7 DDKT and 8 LDKT recipients). Among all patients, time to peak uptake (TTP) of the cortex (TTPCX) measured by Tc-99m DTPA renal scan was independently predictive of AR. Moreover, TTPKD (TTP of the whole transplanted kidney) and TTPCX were the only predictors of AR among DDKT recipients. The most accurate predictors were TTPCX and kidney area on renal scan for DDKT and LDKT, respectively. However, these parameters could not predict AR for the opposite donor type. AR could be effectively predicted by Tc-99m DTPA renal scan obtained at 1week post-KT. Different parameters should be applied according to the donor type in the prediction of AR.

Transperitoneal laparoscopic nephrectomy for benign nonfunctioning kidney: Our experience with 84 cases

Background: The transperitoneal laparoscopic nephrectomy provides an optimal working space. It facilitates orientation by extending identifiable anatomic landmarks. The study evaluates the safety, outcome, and complications of the procedure. Materials and Methods: A total of 84 patients with benign nonfunctioning kidney admitted from April 1, 2015 to March 31, 2019 in the Department of Urology, MGM Medical College and Hospital, Navi Mumbai, India were considered for study purposes. The exclusion criteria of the study included uncorrected coagulopathy, active urinary tract infection, pregnancy, and severe cardiopulmonary disease. Preoperative imaging included digital X-ray, kidney ureter bladder, ultrasonography, intravenous pyelogram, computed tomography, intravenous urogram, micturating cystourethrogram, and diethylenetriaminepentaacetic acid renal scan. All operated patients were evaluated for intraoperative and postoperative complications. Results: The mean age of patients was 40.76 years. Of 84 patients, 60 were men and 24 were women. Patients had complaints of ipsilateral flank pain 76 (90.47%), lower urinary tract symptoms 34 (30.95%), and hematuria 18 (21.42%). Causes of benign nonfunctioning kidney were obstructive uropathy secondary to stone in 62 patients (73.81%) followed by neglected pelvic ureteric junction obstruction in 8 (9.53%), renal tuberculosis in 6 (7.14%), chronic pyelonephritis in 6 (7.14%), and renovascular hypertension in 2 (2.38%) patients. Seven patients required conversion to open surgery, secondary to adhesions in four patients, instrument failure in one case, and bleeding in two cases. The mean stay of the patient in the hospital was 4.38 days. Various types of complications occurred in five patients: colonic injury in one, wound infection in three, and incisional hernia in one. Conclusion: Transperitoneal laparoscopic nephrectomy is an effective procedure with minimal morbidity, hospital stay, rapid recovery, and better cosmesis making this the gold standard technique for nephrectomy.

Outcome following renal autotransplantation in renal artery stenosis.

Introduction:With significant advances in the area of interventional radiology, angioplasty and stenting have become preferred first-line treatment in patients with significant renal artery stenosis. However, not all patients have favorable anatomy to undergo minimally invasive treatments, and reconstruction of the renal artery is an option. In select cases, either improved renal function or maintenance of existing function and sometimes resolution of hypertension can follow surgical treatment.Material and Methods:This was a prospective observational study conducted from August 2010 to June 2016. Patients <45 years of age with uncontrolled hypertension secondary to renovascular hypertension (RVH) and refractory to medical management and renal arterial disease unfavorable for percutaneous intervention were included in the study. All patients were evaluated thoroughly using computed tomography angiography and diethylenetriaminepentaacetic acid renal scan. Patients underwent autotransplantation either into the right or left iliac fossa. Some kidneys required bench reconstruction of the renal artery and/or its branches before being implanted into either iliac fossa.Results:Nine patients were included in the study. The mean age was 27 years. Seven were males and two were females. Five patients had bilateral renal artery stenosis. After autotransplantation, initially five patients became free of antihypertensive medicines, but on the follow-up, two patients showed rising trend of blood pressure. The evaluation revealed narrowing at anastomosis site in both patients with salvageable kidney function in one patient. Angioplasty with stenting was done in this patient while the second patient underwent secondary nephrectomy. At 2 years of follow-up, four patients required no antihypertensive medicines.Conclusion:Autotransplantation can be a successful treatment of severe RVH and should be considered in patients with renal arterial disease unfavorable for percutaneous intervention.

MP59-09 FUNCTIONAL CHANGE OF CONTRALATERAL KIDNEY AFTER PARTIAL NEPHRECTOMY USING DIETHYLENE TRIAMINE PENTA-ACETIC ACID (DTPA) RENAL SCINTIGRAPHY: LONG TERM ANALYSIS

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy IV1 Apr 2017MP59-09 FUNCTIONAL CHANGE OF CONTRALATERAL KIDNEY AFTER PARTIAL NEPHRECTOMY USING DIETHYLENE TRIAMINE PENTA-ACETIC ACID (DTPA) RENAL SCINTIGRAPHY: LONG TERM ANALYSIS Se Young Choi, Jeman Ryu, Jae Hyeon Han, Wonchul Lee, Han Kyu Chae, Sangjun Yoo, Dalsan You, In Gab Jeong, Cheryn Song, Bumsik Hong, Hanjong Ahn, and Choung-Soo Kim Se Young ChoiSe Young Choi More articles by this author , Jeman RyuJeman Ryu More articles by this author , Jae Hyeon HanJae Hyeon Han More articles by this author , Wonchul LeeWonchul Lee More articles by this author , Han Kyu ChaeHan Kyu Chae More articles by this author , Sangjun YooSangjun Yoo More articles by this author , Dalsan YouDalsan You More articles by this author , In Gab JeongIn Gab Jeong More articles by this author , Cheryn SongCheryn Song More articles by this author , Bumsik HongBumsik Hong More articles by this author , Hanjong AhnHanjong Ahn More articles by this author , and Choung-Soo KimChoung-Soo Kim More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1825AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Partial nephrectomy aims to maintain renal function by nephron sparing. However, the functional change of contralateral kidney remains to be known. We evaluated the functional change in contralateral kidney using DTPA renal scan and determined the predicting factors of contralateral kidney function after partial nephrectomy. METHODS From 2001 to 2012, 699 patients underwent partial nephrectomy and we performed DTPA renal scan before and after surgery in all patients to assess the exact renal function of each kidney. Patients were divided into 3 groups according to initial contralateral glomerular filtration rate (GFR) (group 1: <30ml/min/1.73m2, group 2: 30~45ml/min/1.73m2, and group 3: ≥45ml/min/1.73m2). We evaluated separate renal functions using DTPA up to 5 year after surgery. Logistic regression analysis was used to identify the factors associated with increased GFR of contralateral kidney. Kaplan-Meier method was used for overall survival. Median follow-up period was 45.1 month. RESULTS Patients of group 1 were older age (64.2±9.8 vs 55.0±11.0 vs 48.0±9.5, p<0.001), more hypertension history (59.5% vs 39.3% vs 20.9%, p<0.001), worse American society of anesthesiologists (ASA) score (≥2; 94.0% vs 89.5% vs 80.2%, p<0.001), and shorter ischemic time (19.9±8.0 vs 22.3±8.7 vs 22.8±8.9, p=0.025) among three groups (respectively). Tumor size, resected weight, RENAL nephrometry score and ischemic type were not different among three groups (p=0.293, p=0.255, p=0.582 and p=0.967, respectively). The mean ipsilateral GFR changes were -7.5%, -1.6%, and -21.2% in group 1, 2, and 3, respectively and contralateral GFR changes were 33.9%, 19.9%, and 7.3% in group 1, 2, and 3, respectively at 5 year after partial nephrectomy. On multivariable analysis, ASA score (OR 0.54, 95% confidence interval [CI] 0.31-0.92 p=0.0277) and preoperative contralateral GFR (OR 0.97, 95% CI 0.95-0.99 p=0.0011) were the significant predictive factors for increased GFR of contralateral kidney within 5 years. 5 year overall survival rates were 86.1%, 93.1% and 97.4% in group 1, 2, 3, respectively. CONCLUSIONS Contralateral kidney compensated for the functional loss of ipsilateral kidney. The increase of GFR in contralateral kidney is more prominent in healthy patients with decreased contralateral renal function. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e784 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Se Young Choi More articles by this author Jeman Ryu More articles by this author Jae Hyeon Han More articles by this author Wonchul Lee More articles by this author Han Kyu Chae More articles by this author Sangjun Yoo More articles by this author Dalsan You More articles by this author In Gab Jeong More articles by this author Cheryn Song More articles by this author Bumsik Hong More articles by this author Hanjong Ahn More articles by this author Choung-Soo Kim More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Correlation of Glomerular Filtration Rate Between Renal Scan and Estimation Equation for Patients With Scleroderma

BackgroundRenal involvement in scleroderma is life-threatening. Early detection of a deterioration of the glomerular filtration rate (GFR) is needed to preserve kidney function. ObjectivesTo (A) determine the correlation between (1) estimated GFR (eGFR) using 4 different formulae and (2) measured GFR (mGFR) using isotopic renal scan in Thai patients with scleroderma with normal serum creatinine and (B) to define the factors influencing eGFR. MethodA cross-sectional study was performed in adult Thai patients with scleroderma at Srinagarind Hospital, Khon Kaen University, between December 2013 and April 2015. GFR was measured using the gold standard Tc-99m DTPA (Tc-99m diethylenetriaminepentaacetic acid) renal scan. We compared the latter with the eGFR, calculated using the Cockroft-Gault formula, Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and creatinine clearance equation. ResultsA total of 76 patients with scleroderma (50 women and 26 men) with median age 54.8 years (interquartile range: 47.4 to 58.9) were enrolled. Mean disease duration was 5.6 ± 4.5 years. Median value of mGFR was 100.1 ± 27.6mL/minute/1.73m². There was a correlation between mGFR from the Tc-99m DTPA renal scan and the eGFR using the Cockroft-Gault formula, MDRD and CKD-EPI equation (P = 0.01, <0.001 and <0.001, respectively), but no correlation with eGFR using the creatinine clearance equation (P = 0.27). Body weight, prednisolone use and systolic blood pressure (SBP) had a negative association with mGFR (P = 0.01, 0.01 and 0.007, respectively). After multivariate analysis, SBP was the only clinical parameter that influenced mGFR (P = 0.03). ConclusionsThe Cockroft-Gault formula, MDRD study equation and CKD-EPI were useful formulae for assessing GFR in Thai patients with scleroderma. Higher SBP was associated with a lower GFR.

Renal Function is Associated with Nephrometry Score After Partial Nephrectomy: A Study Using Diethylene Triamine Penta-Acetic Acid (DTPA) Renal Scanning.

The aim of this study was to evaluate the effect of renal tumor anatomical characteristics on renal function change after partial nephrectomy using the scoring systems and the glomerular filtration rate (GFR) estimated from diethylene triamine penta-acetic acid (DTPA) scans. Patients who underwent DTPA renal scans before and after partial nephrectomy from January 2009 to December 2011 were identified retrospectively. The anatomical characteristics of renal tumors were standardized using the RENAL, PADUA and C-index scoring systems. Associations between scoring systems and change in GFRs were evaluated using a correlation coefficient. Predictors of GFR change and postoperative new-onset chronic kidney disease (CKD) after partial nephrectomy were assessed. A total of 185 patients with a mean tumor size of 2.6 cm (median 2.3, range 0.5-10) were identified. Mean ischemia time was 21.5 min. The last DTPA renal scan was performed at a mean follow-up duration of 23.3 months after surgery, and the mean decrease in GFR was 8.1 ml/min. By multivariable analysis, preoperative GFR (β = -039; p < 0.001), RENAL complexity score (β = -5.32; p < 0.001), and C-index complexity (β = -5.19; p < 0.001) were independent predictors of decreased GFR on DTPA. Of 175 patients in whom preoperative estimated GFR (eGFR) was > 60 ml/min/1.73 m(2), CKD developed in 14 (8 %) patients after surgery. Independent factors predicting new-onset CKD were preoperative eGFR (odds ratio [OR] 0.91; p = 0.047), age (OR 1.13; p = 0.003), and diabetes (OR 5.10; p = 0.038). Although each scoring system describing the complexity of renal tumors correlates with change in GFR after partial nephrectomy, RENAL and C-index score were significantly predictive of GFR reduction.

Estimation of GFR using β-trace protein in children.

Sex may affect the performance of small molecular weight proteins as markers of GFR because of differences in fat mass between the two sexes. The hypothesis was that the diagnostic performance of β-trace protein, a novel marker of GFR, would be significantly better in boys than in girls. GFR, height, weight, serum creatinine, and β-trace protein were measured in 755 children and adolescents (331 girls) undergoing (99)technetium diethylenetriamine penta-acetic acid renal scans from July of 1999 to July of 2006. Boys and girls were separated into formula generation cohorts (284 boys and 220 girls) and formula validation cohorts (140 boys and 111 girls). GFR-estimating formulas on the basis of β-trace protein, creatinine, and height were derived using stepwise linear regression analysis of log-transformed data. The slope of the regression lines of the sex-specific eGFRs were compared. Bland-Altman analysis was used for testing agreement between (99)technetium diethylenetriamine penta-acetic acid GFR and calculated GFR both with this equation in boys and girls as well as previously established Benlamri, White, and Schwartz formulas. In the stepwise regression analysis, β-trace protein (R(2)=0.73 for boys and R(2)=0.65 for girls) was more important than creatinine (which increased R(2) to 0.81 for boys and R(2) to 0.75 for girls) and height (which increased R(2) to 0.88 for boys and R(2) to 0.80 for girls) in the data generation groups. GFR can be calculated using the following formulas:[Formula: see text]and[Formula: see text]Bland-Altman analysis showed better performance in boys than in girls. The new formulas performed significantly better than the previous Benlamri, White, and Schwartz formulas with respect to bias, precision, and accuracy. Improved and sex-specific formulas for the estimation of GFR in children on the basis of β-trace protein, serum creatinine, and height are now available.

MRI in patients with chronic obstructive uropathy and compromised renal function: a sole method for morphological and functional assessment

The aim of this study was to assess the role of MRI as a single modality for anatomical and functional evaluation of obstructed kidneys in patients with compromised renal function. The study included 96 adults with unilateral or bilateral chronic obstructive hydronephrosis and compromised renal function (serum creatinine >or=1.8 mg dl(-1)). Patients were subjected to gadolinium-enhanced MRI (Gd-MRI), which determined the anatomy of both renoureteral units, as well as their function, through selective calculation of the glomerular filtration rate (GFR) of each kidney. All patients underwent a technetium-99m diethylenetriamine-pentaacetic acid renal scan. Moreover, a correlation was made between the GFR determined by Gd-MRI and the isotope GFR. The study comprised 59 males and 37 females. A comprehensive MRI study detected the cause of obstruction in all kidneys with non-calcular obstruction (sensitivity of 100%) and in 21 kidneys with calcular obstruction (sensitivity of 70%). The overall sensitivity of MRI combined with plain X-ray of the abdomen and ultrasound in the detection of various causes of obstruction was 97%. A comparison between the isotope GFR of the obstructed kidneys and the corresponding magnetic resonance urography (MRU) GFR showed perfect correlation. In conclusion, combined static and dynamic MRU is a promising technique that allows anatomical and functional evaluation of obstructed kidneys in patients with impaired renal function but, owing to the possible risk of nephrogenic systemic fibrosis in patients with a GFR <30 ml min(-1), the lowest possible dose of the most stable Gd-macrocyclic chelates should be used if a functional MRI study is required.

A novel technique of ureteroneocystostomy (extravesical seromuscular tunnel): a preliminary clinical study

Objectives. To present our initial clinical experience with the new technique of extravesical seromuscular tunnel ureteroneocystostomy. Methods. The technique was performed in 21 patients for different indications; the most common was unilateral bilharzial stricture of the lower end of the ureter. The patients were regularly seen every 3 months during the first year, every 6 months during the second year, and annually thereafter during a follow-up period of 24.2 ± 10.2 months. A chemical profile, urine culture, and renal ultrasound scan were performed at every visit. A technetium-99m diethylenetriaminepentaacetic acid renal scan was carried out at least once every 12 months. Ascending cystography and intravenous urography were done at least once during the entire follow-up period. Results. The postoperative course was uneventful in all patients. Improvement in renal function was achieved in 16 patients and the remaining 5 experienced stabilization. Improvement of the configuration of the corresponding renoureteral unit was observed in all but 4 patients who had stabilization to almost that of the preoperative condition. None of the 21 patients demonstrated vesicoureteral reflux during the follow-up period. Conclusions. The new technique of extravesical seromuscular tunnel is suitable for reimplantation of the dilated ureters. Other studies with a larger number of patients and a longer duration of follow-up are necessary to confirm these results.

LONG-TERM FOLLOWUP OF ELDERLY DONORS IN A LIVE RELATED RENAL TRANSPLANT PROGRAM

It is a concern that elderly donors may have increased risks in the perioperative period due to age related changes in various organ systems. Nephrosclerosis, atherosclerosis and low glomerular filtration rate may portend a poor graft outcome. We performed a study to determine function and outcome of kidneys from elderly donors. A retrospective analysis of our live related transplant program from November 1989 to December 1998 revealed that 112 donors were older than 55 years (range 55 to 81). Of the recipients of these kidneys from elderly donors 98 had a followup of more than 2 years (group 1), and they were compared to a cohort of 87 patients whose kidney donors were younger than 45 years (group 2). Allograft function was evaluated by serum creatinine and differential glomerular filtration rate was determined by (99m)technetium diethylenetriamine pentaacetic acid renal scan. All donors were followed regularly. Mean donor age plus or minus standard deviation was 57.4 +/- 4.3 and 31.4 +/- 7.6 years in groups 1 and 2, respectively. Mean followup plus or minus standard deviation was 42.44 +/- 20.46 months in group 1 and 40.04 +/- 27.28 months in group 2. The 1-year graft survival rate was 91.84% and 88. 51%, and the 5-year graft survival rate was 72.72% and 75.13% in groups 1 and 2, respectively. Serum creatinine was 1.5 +/- 0.65 and 1.7 +/- 1.52 mg./dl. in group 1 and 1.4 +/- 0.55 and 1.5 +/- 1.41 mg. /dl. in group 2 at 1 year and last followup, respectively. Glomerular filtration rate was 37.2 +/- 11.2 and 37.3 +/- 10.7 ml. per minute in group 1 and it was 45.3 +/- 8.6 and 47.7 +/- 11.3 ml. per minute in group 2 at 1 year and last followup, respectively. Acute rejection rate was significantly higher in group 1 (42%) compared to group 2 (19%). Both groups were comparable in terms of infectious episodes, antihypertensive requirement and incidence of acute tubular necrosis. There was no added morbidity for elderly compared to younger donors. In view of acute donor shortage and if properly screened, elderly kidneys can be used without increasing the risk to donor or compromising graft outcome.

SUPRANORMAL RENOGRAPHIC DIFFERENTIAL RENAL FUNCTION IN CONGENITAL HYDRONEPHROSIS: FACT, NOT ARTIFACT

Purpose Children with unilateral hydronephrosis, who had been prospectively examined with diethylenetriaminepentaacetic acid (DTPA) and dimercapto-succinic acid (DMSA) renography, were evaluated to determine whether supranormal renographic differential renal function exists. Materials and Methods A total of 54 children with congenital single system hydronephrosis underwent abdominal ultrasound, voiding cystourethrogram, and DTPA and DMSA renal scans. None had abnormalities of the bladder or contralateral kidney. Differential renal function greater than 55% was defined as supranormal. Results Of the 54 patients 15 (28%) with a median age of 4 months (range 0.5 to 66) were identified with supranormal renographic renal function on either DTPA or DMSA. Supranormal renographic renal function was detected by DMSA in 9 cases (mean 57 +/− 2%), DTPA in 8 (mean 58 +/− 2%) and both in 2 (mean 57 +/− 2%). Average function demonstrated in the 15 patients was 55 +/− 3% (range 51 to 62) with DMSA which was not different from that found with DTPA (mean 55 +/− 4%, range 46 to 61%). The kidneys with supranormal renographic renal function were significantly larger than hydronephrotic controls according to longitudinal parenchymal area on DMSA. Mean followup was 20 months for 13 patients, with 8 of 13 (62%) undergoing pyeloplasty. Followup DTPA renal scans available in 9 children revealed persistent supranormal function in 6, despite pyeloplasty in 3. Conclusions Supranormal renographic differential renal function does exist in congenital hydronephrosis and when found the kidneys are consistently enlarged. The position of supranormal renographic renal function in the management algorithm of hydronephrosis remains to be elucidated as it does not appear to be a benign prognostic factor.

Primary Dilated Megaureter: Long-Term Followup

Previously, we reported on the changing concepts in the management of 35 neonates with primary obstructive megaureters, 25 of whom were observed without surgery for a mean of 28 months while 10 were surgically treated. We report the long-term outcome of the 25 patients who were managed without surgery. This group consists of 19 male and 6 female neonates with 19 unilateral and 6 bilateral dilated ureters. Of the patients 17 presented with an antenatal diagnosis of hydronephrosis, 2 with infection and 6 with incidental findings. None of the patients had vesicoureteral reflux. Followup serial imaging (2 or more studies per case) consisted of excretory urography in 18 of the 25 cases, diethylenetriaminepentaacetic acid renal scan in 16 and/or sonogram in 10. Mean followup was 7.3 years (range 4.8 to 12.4) for 24 patients and 1 was lost to followup after 1.5 years. Excretory urography showed improvement in urinary tract dilatation in 12 cases and stable dilatation in 6. Renal scans demonstrated expected interval increases in the glomerular filtration rate with age without any deterioration in per cent of renal function in all 16 cases. None of the patients had stones, pain or pyelonephritis. We conclude that it is safe to follow a select group of patients with primary dilated megaureters in the absence of vesicoureteral reflux. We recommend antibiotic prophylaxis and serial urinary tract imaging to confirm renal growth and preservation of renal function.

Prenatal Adrenal Hemorrhage Confirmed by Postnatal Surgery

A case is reported of massive adrenal hemorrhage in a newborn with evidence of bleeding in utero. A large cystic mass noted on prenatal ultrasonography at 20 weeks of gestation was followed by serial examinations until birth at 38 weeks of gestation. Postnatal evaluation included abdominal sonography, diethylenetriaminepentaacetic acid renal scan, voiding cystourethrography and abdominal plain film. Surgical exploration confirmed massive adrenal hemorrhage.

Nonobstructive dilatation of upper urinary tract may later convert to obstruction

We report on 5 babies found to have pyelocaliectasis or hydroureteronephrosis antenatally who were evaluated soon after birth because of persistent mild or moderate upper urinary tract dilatation. In each instance, vesicoureteral reflux was absent and the technetium-99m diethylenetriaminepentaacetic acid renal scan revealed good function in the ipsilateral kidney. Renogram curves, after furosemide, did not show an obstructed pattern. Indeed, allowing for the dilatation, the drainage patterns were thought to be normal. In each instance the patient represented or was found on follow-up to have increased dilatation. Renograms were then repeated, using the same radiopharmaceutical and dose of diuretic. An obstructive pattern was seen in each instance. These significant observations demonstrate that nonobstructive hydronephrosis, diagnosed prenatally, may later convert to obstruction at the ureteropelvic junction (UPJ) or in the juxtavesical ureter (UVJ). Thus, careful follow-up, for a period yet to be determined, is desirable in patients in whom the initial postnatal evaluation does not demonstrate obstruction by current criteria.

Salvage Pyeloplasty in Nonvisualizing Hydronephrotic Kidney Secondary to Ureteropelvic Junction Obstruction

The potential recoverability of an obstructed kidney detected by maternal antenatal ultrasound cannot be predicted by the currently available methods of investigation. Early repair in the presence of little parenchymal tissue may result in marked improvement in renal function. During the last 2 years 8 male and 2 female neonates with antenatal presentation of hydronephrosis were referred for postnatal evaluation. All patients had palpable renal masses clinically, which were unilateral (left side) in 9 and bilateral in 1. Blood urea nitrogen and creatinine were normal in all patients. Postnatal imaging included abdominal ultrasonography, voiding cystourethrography, excretory urography and quantitative functional evaluation with diuretic diethylenetriaminepentaacetic acid renal scan. Nonvisualization of a left hydronephrotic kidney was detected in all cases. Antegrade pyelography at surgical exploration (at age less than 2 months) was done to outline the anatomy. Stretched thinned out renal parenchymal tissue over a hugely distended renal pelvis was present and dismembered reduction pyeloureteroplasty was performed. A nephrostomy tube and ureteral stent were used. Followup ranged between 6 and 24 months. Remarkable recovery of renal function, more than 100% on renal scintigraphy, was noted postoperatively in all patients.

Clinical Outcome of Fetal Uropathy. II. Sensitivity of Echography for Prenatal Detection of Obstructive Pathology

Among 8,579 neonates born between February 1, 1981 and March 31, 1987, and cleared by prenatal sonography for significant urinary tract abnormality 158 subsequently were hospitalized because of signs or symptoms of urinary tract disease, predominantly urinary tract infection. Evaluation of these 158 patients revealed 24 with vesicoureteral reflux, 7 with duplicated systems (2 of which showed reflux), 1 with the syndrome of Fraley, 1 with pyelectasis and 5 with mild hydronephrosis (3 secondary to reflux and 2 with diethylenetriaminepentaacetic acid renal scans considered to be nonobstructed). There was no incidence of significant obstructive uropathy that had been missed by the previous prenatal sonography and that surfaced subsequently to cause morbidity in this series. The principal disorder of the urinary tract that may fail prenatal investigation is vesicoureteral reflux.

Captopril renal scintigraphy[mdash ]An advance in the detection and treatment of renovascular hypertension

Despite the risks associated with renovascular hypertension and the durable benefits of revascularization, the detection of patients with renovascular hypertension and the selection of those who will benefit from interventional therapy remains a challenge. We have previously documented the reliability of captopril renal scintigraphy in predicting angiographically significant renal artery stenosis in patients suspected of having renovascular hypertension. In the present study we report our recent experience with this noninvasive technique in predicting outcome after revascularization. Captopril renal scintigraphy involves the administration of 50 mg of captopril 3 hours after a baseline technitium-99m diethylenetriaminepentaacetic acid renal scan and 1 hour before a repeat captopril renal scintigraphy scan. Nineteen of the last 70 patients with clinically suspected renovascular hypertension undergoing captopril renal scintigraphy had abnormal renal scan outcomes, and 17 had a decrease in flow or function after captopril (positive captopril renal scintigraphy). Eight of these 17 with abnormal findings on captopril renal scintigraphy underwent revascularization, and the hypertension was cured or improved in six of the eight: two of three after surgical bypass grafting and four of five after angioplasty. In the seven surviving patients with abnormal renal scan results but no change with captopril (negative captopril renal scintigraphy), improvement in hypertension after treatment occurred in only one: one of two after nephrectomy, zero of three after bypass surgery, and zero of two after angioplasty (p less than 0.05). We conclude that captopril renal scintigraphy is an accurate predictor of hypertension response to revascularization. Further evaluation of this new noninvasive technique for assessing patients with suspected renovascular hypertension appears warranted.

Captopril renal scintigraphy—An advance in the detection and treatment of renovascular hypertension

Despite the risks associated with renovascular hypertension and the durable benefits of revascularization, the detection of patients with renovascular hypertension and the selection of those who will benefit from interventional therapy remains a challenge. We have previously documented the reliability of captopril renal scintigraphy in predicting angiographically significant renal artery stenosis in patients suspected of having renovascular hypertension. In the present study we report our recent experience with this noninvasive technique in predicting outcome after revascularization. Captopril renal scintigraphy involves the administration of 50 mg of captopril 3 hours after a baseline technitium-99m diethylenetriaminepentaacetic acid renal scan and 1 hour before a repeat captopril renal scintigraphy scan. Nineteen of the last 70 patients with clinically suspected renovascular hypertension undergoing captopril renal scintigraphy had abnormal renal scan outcomes, and 17 had a decrease in flow or function after captopril (positive captopril renal scintigraphy). Eight of these 17 with abnormal findings on captopril renal scintigraphy underwent revascularization, and the hypertension was cured or improved in six of the eight: two of three after surgical bypass grafting and four of five after angioplasty. In the seven surviving patients with abnormal renal scan results but no change with captopril (negative captopril renal scintigraphy), improvement in hypertension after treatment occurred in only one: one of two after nephrectomy, zero of three after bypass surgery, and zero of two after angioplasty (p < 0.05). We conclude that captopril renal scintigraphy is an accurate predictor of hypertension response to revascularization. Further evaluation of this new noninvasive technique for assessing patients with suspected renovascular hypertension appears warranted.