Division of Pediatric Urology, Department of Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Department of Radiology, University of Cincinnati, Cincinnati, Ohio.
J Urol. 2018 Aug;200(2):440-447. doi: 10.1016/j.juro.2018.03.126. Epub 2018 Apr 6.
While serial renal ultrasound is often used as an alternative to functional renal imaging in children followed for hydronephrosis, it is unclear whether a lack of hydronephrosis progression safeguards against loss of renal function. In this study we characterize the association between findings on serial renal ultrasound and diuretic renography in children with severe unilateral hydronephrosis.
We retrospectively reviewed imaging among patients younger than 18 years old with a history of severe unilateral hydronephrosis, 2 renal ultrasounds and 2 diuretic renograms. Each pair of renal ultrasounds was interpreted by an independent blinded diagnostic radiologist and compared to a contemporaneous diuretic renogram. Change in hydronephrosis was considered as 1) a change in hydronephrosis grade or 2) any change by radiologist interpretation. A 5% or greater change in split differential function was considered significant. Chi-square and Spearman correlation analyses were performed.
A total of 85 children were evaluated. Increased hydronephrosis was noted in 11.8% of children by grade and 32.9% by radiologist interpretation. Split differential renal function worsened by 5% or more in 17.6% of children. Overall, 13.3% of children with stable or decreased hydronephrosis demonstrated worsening split differential function at an average of 11.8 months. When renal ultrasound and diuretic renograms were directly compared, the Spearman correlation was poor (r = 0.24, 95% CI 0.03 to 0.43).
The overall correlation between imaging modalities was poor, and 13.3% of children with stable or decreased hydronephrosis had worsening of split differential renal function. These findings are important to consider when counseling nonoperatively managed children followed without diuretic renography.
在因肾积水而接受随访的儿童中，虽然连续肾脏超声通常被用作功能肾脏成像的替代方法，但尚不清楚肾积水进展的缺乏是否能保护肾功能不受损害。在这项研究中，我们描述了严重单侧肾积水患儿连续肾脏超声与利尿剂肾图之间的关联。
我们回顾性分析了年龄小于 18 岁、单侧肾积水严重的患者的影像学资料，这些患者接受了 2 次肾脏超声和 2 次利尿剂肾图检查。每对肾脏超声由独立的盲法诊断放射科医生进行解读，并与同期的利尿剂肾图进行比较。肾积水的变化被定义为 1）肾积水分级的变化，或 2）放射科医生解读的任何变化。肾分肾功能的变化大于或等于 5%被认为具有统计学意义。采用卡方检验和斯皮尔曼相关分析。
共评估了 85 例患儿。根据分级，11.8%的患儿肾积水加重，32.9%的患儿经放射科医生解读肾积水加重。17.6%的患儿分肾功能恶化 5%或以上。总体而言，13.3%的肾积水稳定或减少的患儿在平均 11.8 个月时出现分肾功能恶化。当直接比较肾脏超声和利尿剂肾图时，斯皮尔曼相关系数较差（r=0.24，95%CI 0.03 至 0.43）。
影像学检查之间的总体相关性较差，13.3%的肾积水稳定或减少的患儿分肾功能恶化。在对未接受利尿剂肾图检查而接受非手术治疗的患儿进行咨询时，需要考虑这些发现。
