García Alonso M P, Mitjavila Casanovas M, Penín González F J, Balsa Bretón M A, Pey Illera C
Servicio de Medicina Nuclear, Hospital Universitario de Getafe, Madrid, Spain.
An Pediatr (Barc). 2007 May;66(5):459-67. doi: 10.1157/13102509.
To investigate the value of diuretic renography in patients with prenatally diagnosed unilateral hydronephrosis.
We reviewed 44 patients who underwent ultrasonography in the first week of life and 1 month after birth, and cystography and diuretic renography at 1 month to evaluate differential renal function and the diuretic washout pattern. Patients with vesicoureteral reflux were followed-up according to the protocol for this disorder. In the remaining patients, ultrasonography and/or diuretic renography was performed every 3-6 months.
In 4/44 patients vesicoureteral reflux was detected as cause a of hydronephrosis. In the remaining 40 patients, diuretic renography showed a washout pattern not suggestive of obstruction in 32 (only one patient needed surgery due to pyohydronephrosis). An indeterminate washout pattern was detected in one patient (who required surgery due to worsening of the washout pattern). A pattern suggestive of obstruction was detected in seven patients, four of whom required surgery (three due to a decrease in differential renal function and one due to worsening of the degree of pelvic dilatation).
Diuretic renography is highly useful in risk stratification and in the management of newborn infants with hydronephrosis since infants with washout patterns not suggestive of obstruction will rarely develop obstructive hydronephrosis and can initially be followed-up with ultrasonography alone. In indeterminate and obstructive patterns, however, close monitoring that includes diuretic renography is mandatory.
探讨利尿肾图在产前诊断为单侧肾积水患者中的价值。
我们回顾性分析了44例在出生后第一周及出生后1个月接受超声检查，以及在出生后1个月接受膀胱造影和利尿肾图检查的患者，以评估分肾功能及利尿清除模式。对存在膀胱输尿管反流的患者按照该疾病的诊疗方案进行随访。其余患者每3 - 6个月进行超声检查和/或利尿肾图检查。
44例患者中，4例检测到膀胱输尿管反流是肾积水的病因。其余40例患者中，利尿肾图显示32例患者的清除模式不提示梗阻（仅1例因肾盂积脓需要手术）。1例患者检测到不确定的清除模式（该患者因清除模式恶化需要手术）。7例患者检测到提示梗阻的模式，其中4例需要手术（3例因分肾功能下降，1例因肾盂扩张程度加重）。
利尿肾图在新生儿肾积水的风险分层及管理中非常有用，因为清除模式不提示梗阻的婴儿很少会发展为梗阻性肾积水，最初可仅通过超声进行随访。然而，对于不确定及梗阻性模式，必须进行包括利尿肾图在内的密切监测。
