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Is a Reassuring MAG-3 Diuretic Renal Scan Really Reassuring?

Lauren N Wood1, Colby E Souders1, Andrew L Freedman1

  • 1Division of Urology, Cedars-Sinai Medical Center, Los Angeles, Calif., USA.

Current Urology
|September 29, 2018
PubMed
Summary
This summary is machine-generated.

A reassuring mercaptoacetyltriglycine-3 (MAG-3) diuretic scan in children with high-grade hydronephrosis generally indicates safe observation. Most cases resolved without surgery, suggesting non-operative management is often appropriate.

Keywords:
HydronephrosisMag-3 diuretic nuclear scanUreteropelvic junction obstruction

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Area of Science:

  • Pediatric Nephrology
  • Diagnostic Imaging
  • Urology

Background:

  • Antenatally detected hydronephrosis is common in infants.
  • The mercaptoacetyltriglycine-3 (MAG-3) diuretic renal scan assesses kidney function and obstruction.
  • The utility of a reassuring MAG-3 scan in high-grade hydronephrosis requires further clarification.

Purpose of the Study:

  • To evaluate if a reassuring MAG-3 scan accurately predicts the absence of obstruction in pediatric high-grade hydronephrosis.
  • To determine if infants with high-grade hydronephrosis and a reassuring MAG-3 scan can be safely observed.

Main Methods:

  • Retrospective review of 22 infants (0-3 months) with prenatal diagnosis of Society of Fetal Urology grade 3-4 hydronephrosis.
  • All infants underwent a MAG-3 diuretic nuclear renal scan.
  • Analysis of scan results, hydronephrosis resolution, and need for intervention.

Main Results:

  • 16 of 25 renal units had reassuring MAG-3 scans (T½ < 10 min); 94% resolved spontaneously.
  • 9 of 25 renal units had indeterminate MAG-3 scans (T½ 10-20 min); 89% resolved spontaneously.
  • Only one renal unit with a reassuring scan ultimately required pyeloplasty after a year of follow-up.

Conclusions:

  • A reassuring MAG-3 scan is a reliable indicator for safe observation in most pediatric cases of persistent hydronephrosis.
  • Observation with serial ultrasounds may be a suitable alternative to surgery for moderate to severe hydronephrosis with reassuring or indeterminate MAG-3 scans.
  • Non-operative management appears safe and effective for the majority of infants with antenatally detected hydronephrosis and reassuring MAG-3 scan findings.