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Assessment of pediatric hydronephrosis using output efficiency
C A Saunders1, K K Choong, G Larcos
1Department of Nuclear Medicine and Ultrasound, Westmead Hospital, NSW, Australia.
Summary
Renal output efficiency (OE) aids in diagnosing pediatric hydronephrosis. This study found OE improves diagnostic accuracy, with normal kidneys exceeding 89% and unobstructed hydronephrotic kidneys exceeding 79%.
Area of Science:
- Pediatric Nephrology
- Diagnostic Imaging
- Renal Physiology
Background:
- Diagnosing obstruction in pediatric hydronephrosis and renal impairment is challenging.
- Renal output efficiency (OE) offers a method to normalize washout based on renal function, potentially improving diagnostic accuracy.
Purpose of the Study:
- To establish normal ranges for OE in infants and children.
- To assess the diagnostic accuracy of OE in pediatric hydronephrosis cases.
Main Methods:
- 99mTc-labeled mercaptoacetyl-triglycine scintigraphy was performed on 74 children with 91 hydronephrotic kidneys.
- Procedures included intravenous volume expansion, furosemide diuresis, and urethral catheterization if needed.
- Image interpretation involved visual assessment, differential function, clearance half-time, and OE, with final diagnosis based on surgical findings or long-term follow-up.
Main Results:
- Obstruction was diagnosed in 22 of 91 hydronephrotic kidneys.
- The overall diagnostic accuracy of OE was 89%.
- Reduced OE and decreased renal uptake were independently predictive of obstruction.
Conclusions:
- OE enhances the diagnostic accuracy of diuretic renography for pediatric hydronephrosis with suspected obstruction.
- Normal kidneys should have OE >89%, while unobstructed hydronephrotic kidneys should have OE >79%.