Diuretic 99mTc DTPA renography in assessment of renal function and drainage in infants with antenatally detected hydronephrosis

dr Marija Radulović; Dragan Pucar; Ljiljana Jauković; Marija Šišić; Zoran Krstić; Boris Ajdinović

doi:10.2298/6591

dr Marija Radulović Institut za nuklearnu medicinu Vojnomedicinska akademija
Dragan Pucar 1Institute of Nuclear Medicine, Military Medical Academy, Belgrade, Serbia
Ljiljana Jauković 1Institute of Nuclear Medicine, Military Medical Academy, Belgrade, Serbia
Marija Šišić 1Institute of Nuclear Medicine, Military Medical Academy, Belgrade, Serbia
Zoran Krstić 2 University Childrens Clinic, Belgrade, Serbia
Boris Ajdinović 1Institute of Nuclear Medicine, Military Medical Academy, Belgrade, Serbia

DOI: https://doi.org/10.2298/6591

Abstract

Background/Aim. The controversy over the postnatal management of infants with antenataly detected hydronephrosis (ANH) still exists. We presented the results of diuretic ^99mTc diethylenetriamine pentaacetic acid (DTPA) renography in 30 infants with the antenatal diagnosis of unilateral renal pelvic dilatation. The aim of this study was to assess the renal function determined by the pattern of drainage and split renal function (SRF) on diuretic renography and to correlate these findings with anteroposterior pelvic diameter (APD) estimated by ultrasonography. Methods. A total of 30 infants with 60 renal units (RU) (25 boys and 5 girls, median age 6.0 months, range 2–24) presented with unilateral hydronephrosis on ultrasound in the newborn period, underwent DTPA diuretic renal scintigraphy (F+15 protocol). The median APD evaluated on perinatal ultrasound was 15 mm (range 5–30). The postnatal associated clinical diagnosis were pelviureteric junction obstruction (PUJ), simple hydronephrosis, megaureter, vesicoureteral reflux (VUR) and posterior urethral valves in 11, 10, 6, 2 and 1 infant, respectively. Images and Tmax/2 after diuretic stimulation on the background subtracted renographic curves were used as the criteria for classifying the drainage as good, partial, and poor or no drainage. The SRF was calculated with the integral method. Results. Good drainage was shown in 36/60, partial drainage in 13/60 and poor or no drainage in 11/60 RU. The SRF > 40% was observed in 55/60 RU, with no RU showing SRF lower than 23.5%. In infants with severe ANH the obstruction was not excluded in 94.1%. Conclusion. Diuretic renography in antenatally detected hydronephrosis should be a useful tool in postnatal follow up, especially in differentiating nonobstructive hydronephrosis from obstructive. It is also importanat to assess and monitor the SRF. Our results suggest that even in the presence of partial or no drainage, SRF may not be significantly impaired.

Key words:

infant; hydronephrosis; prenatal diagnosis; radioistope renography

References

Mallik M, Watson AR. Antenatally detected urinary tract abnormalities: more detection but less action. Pediatr Nephrol 2008; 23(6): 897−904.

Ek S, Lidefeldt K, Varricio L. Fetal hydronephrosis; preva-lence, natural history and postnatal consequences in an unselected population. Acta Obstet Gynecol Scand 2007; 86(12): 1463−6.

Sairam S, Al-Habib A, Sasson S, Thilaganathan B. Natural history of fetal hydronephrosis diagnosed on mid-trimester ultrasound. Ultrasound Obstet Gynecol 2001; 17(3): 191−6.

Nguyen HT, Herndon C, Cooper C, Gatti J, Kirsch A, Koko-rowski P, et al. The Society for Fetal Urology consensus statement on the evaluation and management of antenatal hydronephrosis. J Pediatr Urol 2010; 6(3): 212−31.

Sinha A, Bagga A, Krishna A, Bajpai M, Srinivas M, Uppal R, et al. Revised guidelines on management of antenatal hydronephrosis. Indian Pediatr 2013; 50(2): 215−31.

Lee RS, Cendron M, Kinnamon DD, Nguyen HT. Antenatal hydronephrosis as a predictor of postnatal outcome: a meta-analysis. Pediatrics 2006; 118(2): 586−93.

de Kort EH, Bambang OS, Zegers SH. The long-term outcome of antenatal hydronephrosis up to 15 millimetres justifies a noninvasive postnatal follow-up. Acta Paediatr 2008; 97(6): 708−13.

Kim HJ, Jung HJ, Lee HY, Lee YS, Im YJ, Hong CH, et al. Diagnostic value of anteroposterior diameter of fetal renal pelvis during second and third trimesters in predicting postnatal surgery among Korean population: useful information for antenatal counseling. Urology 2012; 79(5): 1132−7.

Longpre M, Nguan A, Macneily AE, Afshar K. Prediction of the outcome of antenatally diagnosed hydronephrosis: a multivariable analysis. J Pediatr Urol 2012; 8(2): 135−9.

Feldman DM, DeCambre M, Kong E, Borgida A, Jamil M, McKenna P, et al. Evaluation and follow-up of fetal hydronephrosis. J Ultrasound Med 2001; 20(10): 1065−9.

Lidefelt K, Herthelius M. Antenatal hydronephrosis: infants with minor postnatal dilatation do not need prophylaxis. Pediatr Nephrol 2008; 23(11): 2021−4.

Westera J, Lambrianides AL, Meyer JP. The management of antenatal hydronephrosis detected on routine ultrasound. J Clin Urol 2013; 6(4): 249−53.

Josephson S. Antenatally detected, unilateral dilatation of the renal pelvis: a critical review. 1. Postnatal non-operative treatment 20 years on – is it safe. Scand J Urol Nephrol 2002; 36(4): 243−50.

Moon DH, Park YS, Jun N, Lee SY, Kim KS, Kim JH, et al. Value of supranormal function and renogram patterns on 99mTc-mercaptoacetyltriglycine scintigraphy in relation to the extent of hydronephrosis for predicting ureteropelvic junction obstruction in the newborn. J Nucl Med 2003; 44(5): 725−31.

Amarante J, Anderson PJ, Gordon I. Impaired drainage on diuretic renography using half-time or pelvic excretion ef-ficiency is not a sign of obstruction in children with a prenatal diagnosis of unilateral renal pelvic dilatation. J Urol 2003; 169(5): 1828−31.

Islek A, Güven AG, Koyun M, Akman S, Alimoglu E. Prob-ability of urinary tract infection in infants with uretero-pelvic junction obstruction: is antibacterial prophylaxis re-ally needed. Pediatr Nephrol 2011; 26(10): 1837−41.

Yavascan O, Aksu N, Anil M, Kara OD, Aydin Y, Kangin M, et al. Postnatal assessment of growth, nutrition, and urinary tract infections of infants with antenatally detected hydronephrosis. Int Urol Nephrol 2010; 42(3): 781−8.

Coelho GM, Bouzada MC, Pereira AK, Figueiredo BF, Leite MR, Oliveira DS, et al. Outcome of isolated antenatal hydronephrosis: a prospective cohort study. Pediatr Nephrol 2007; 22(10): 1727−34.

Thomas DF. Prenatal diagnosis: what do we know of long-term outcomes. J Pediatr Urol 2010; 6(3): 204−11.

Bajpai M, Bal CS, Kalaivani M, Gupta AK. Plasma renin ac-tivity for monitoring vesicoureteric reflux therapy: mid-term observations. J Pediatr Urol 2008; 4(1): 60−4.

Heinlen JE, Manatt CS, Bright BC, Kropp BP, Campbell JB, Frimberger D. Operative versus nonoperative management of ureteropelvic junction obstruction in children. Urology 2009; 73(3): 521−5; discussion 525.

Finnell SM, Carroll AE, Downs SM. Subcommittee on Uri-nary Tract Infection. Technical report – Diagnosis and management of an initial UTI in febrile infants and young children. Pediatrics 2011; 128(3): e749−70.