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Supranormal renal function in unilateral hydronephrosis: does it represent true hyperfunction?

Annelies Maenhout1, Hamphrey Ham, K Ismaili

  • 1Departments of Nuclear Medicine, UZ Gent, Ghent, Belgium.

Pediatric Nephrology (Berlin, Germany)
|October 21, 2005
PubMed
Summary
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Supranormal differential renal function in unilateral hydronephrosis is rare. When observed, it may indicate borderline hypofunction of the contralateral kidney, not necessarily an artifact.

Area of Science:

  • Pediatric Nephrology
  • Nuclear Medicine
  • Urology

Background:

  • The existence of supranormal differential renal function in unilateral hydronephrosis is debated, with some attributing it to technical artifacts.
  • Accurate assessment of individual kidney function is crucial for managing unilateral hydronephrosis in children.

Purpose of the Study:

  • To investigate whether supranormal differential renal function in unilateral hydronephrosis is associated with contralateral kidney hypofunction.
  • To determine the absolute single kidney glomerular filtration rate (SKGFR) in hydronephrotic kidneys exhibiting supranormal differential function.

Main Methods:

  • Retrospective analysis of 92 technetium-99m mercaptoacetyltriglycine (MAG3) renograms from children with unilateral hydronephrosis.
  • Exclusion of patients with specific urological conditions and those who underwent early furosemide injection.

Related Experiment Videos

  • Calculation of differential renal function and absolute single kidney glomerular filtration rate (SKGFR) using chromium-51 ethylene diamine tetra-acetic acid (Cr-EDTA) clearance and the integral method.

    • Main Results:

    • Six out of 92 renograms (approximately 6.5%) showed supranormal relative function (>=55%) in the hydronephrotic kidney.
    • In these cases, the SKGFR of the hydronephrotic kidney was within normal limits.
    • The contralateral kidney demonstrated borderline low SKGFR in all instances of supranormal hydronephrotic kidney function.

    Conclusions:

    • Supranormal differential renal function in unilateral hydronephrosis is infrequent.
    • When observed, it may be linked to subtle hypofunction of the contralateral kidney rather than a technical artifact.
    • This finding underscores the importance of assessing absolute SKGFR for accurate renal function evaluation in pediatric hydronephrosis.