Clinical Follow-Up of Children with Low Differential Function on Diuretic Renogram(cid:31)
Chanisa Chotipanich MD*,***, Joan Rubin BA**, Joseph Lin MD*, Martin Charron MD, FRCP**
Affiliation : (cid:31) This paper was presented as poster at the 50th Annual meeting of the Society of Nuclear Medicine at New Orleans, Louisiana, June 21-25, 2003 * Hospital of the University of Pennsylvania ** The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania *** Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand
Objective : One of the most challenging dilemmas in pediatric urology today is to determine the optimal
management of children with hydronephrotic kidney secondary to suspected ureteropelvic junction obstruc-
tion. Some believe in early surgical management while others believe in conservative management. To better
define these issues, the authors retrospectively reviewed 101 patients with hydronephrosis.
Materials and Methods : The present study was approved by The Children’s Hospital of Philadelphia’s institu-
tional review board and waiver of informed consent for retrospective study. One hundred and one children (72
males and 29 females) of ages of 6 days to 19 years with hydronephrosis with suspected UPJ obstruction
underwent diuretic renograms with 99mTc DTPA. The authors classified the differential renal function into three
groups: Group I: 0-15%, Group II: 16-30%, and Group III: 31-46%.
Results : Forty-one patients with conservative management, 32% (5 in group I: 1 in group II and 7 in group III)
showed improved differential renal function. Non-operative management patients from group I and II showed
no deteriorating renal function and only one case from group III had deteriorating renal function. In opera-
tive management, 78% of group I, 41% of group II, and 25% of group III showed improvement in differential
renal function. In the remaining operative cases, six showed deteriorated differential renal function [1(4%)
group I: 3(18%) group II: 2 (10%) group III] whereas 24 remained stable or unchanged [Group I: 4(17%),
Group II: 7(41%), Group III: 13 (65%)].
Conclusion : The authors recommended conservative management for children with differential renal function
between 16-46%.
Keywords : Hydronephrosis, Diuretic renography, Differential renal function, Pelvic Ureterojunction Obstruc- tion
