Kandur Yasar, Salan Ahmet, Guler Ahmet Gokhan, Tuten Fatih
Department of Pediatric Nephrology, Necip Fazıl City Hospital, Kahramanmaras, Turkey.
Department of Nuclear Medicine, Necip Fazıl City Hospital, Kahramanmaras, Turkey.
Int Urol Nephrol. 2018 Jul;50(7):1199-1204. doi: 10.1007/s11255-018-1893-y. Epub 2018 May 24.
Ureteropelvic junction obstruction (UPJO) is one of the most common causes of hydronephrosis other than transient hydronephrosis. In children with unilateral hydronephrosis, mercaptoacetyltriglycine-3 diuretic renography (MAG) is used to calculate differential renal function and to assess drainage. The aim of our study is to examine whether anteroposterior pelvic diameter on renal ultrasound (US) scan can predict both differential renal function (DFR) and obstruction in pediatric patients, and whether an US adequately identifies those patients who need further investigation. We also aimed to design a study with a larger sample size than previous studies investigating the relationship between MAG and US.
We retrospectively reviewed the MAG, US, dimercaptosuccinic acid scan (DMSA) findings, and medical records of pediatric patients with hydronephrosis and/or atrophy who were at follow-up between January 2013 and December 2016 in our center which is located in the south-east region of Turkey.
Two hundred and twenty-five pediatric patients (M/F = 156/69) with unilateral hydronephrosis but without VUR were enrolled in this study. The mean age of the children was 45.4 ± 48.3 months (range 2-173 months). Sixty-nine patients had obstructive pattern on Tc-MAG. With respect to obstructive pattern, there was a significant difference between the hydronephrosis groups both with 15 and 20 mm border. An APD of greater than 20 mm had 15.8 times (95% CI 5.72-43.69) higher likelihood of having obstruction MAG3 findings. On the other hand, an APD of greater than 15 cm had 9.2 times (95% CI 3.01-28.57) higher likelihood of having obstruction MAG findings. The incidence of urinary tract infections was lower than in the obstructive group than the other groups. The regression analysis showed that an APD of greater than 20 mm was a risk factor for low DRF (OR = 5.208, 95% CI 1.529-17.743, p = 0.008). However, the regression analysis showed that an APD of greater than 15 mm was not a risk factor low DRF.
The combination of ultrasound and MAG provides the necessary anatomical and functional information to follow the degree of obstruction and to decide between surgical intervention and conservative follow-up. Our study supports a threshold of 20 mm rather than 15 mm for severe obstruction and a low DRF. An APD threshold greater than 15 mm did not have a predictive value in DRF estimation.
肾盂输尿管连接处梗阻（UPJO）是除暂时性肾积水外肾积水最常见的原因之一。在单侧肾积水患儿中，巯基乙酰三甘氨酸-3利尿肾图（MAG）用于计算分肾功能并评估引流情况。我们研究的目的是检查肾脏超声（US）扫描时的前后径骨盆直径是否能预测小儿患者的分肾功能（DFR）和梗阻情况，以及超声能否充分识别那些需要进一步检查的患者。我们还旨在设计一项样本量比以往研究MAG与US之间关系的研究更大的研究。
我们回顾性分析了2013年1月至2016年12月在位于土耳其东南部地区的我们中心进行随访的肾积水和/或萎缩小儿患者的MAG、US、二巯基丁二酸扫描（DMSA）结果及病历。
225例单侧肾积水但无膀胱输尿管反流（VUR）的小儿患者（男/女 = 156/69）纳入本研究。患儿的平均年龄为45.4±48.3个月（范围2 - 173个月）。69例患者Tc - MAG显示梗阻型。就梗阻型而言，肾盂积水组在边界为15和20 mm时均存在显著差异。前后径骨盆直径大于20 mm时出现梗阻MAG3结果的可能性高15.8倍（95%可信区间5.72 - 43.69）。另一方面，前后径骨盆直径大于15 cm时出现梗阻MAG结果的可能性高9.2倍（95%可信区间3.01 - 28.57）。尿路感染的发生率在梗阻组低于其他组。回归分析显示，前后径骨盆直径大于20 mm是低分肾功能的危险因素（比值比 = 5.208，95%可信区间1.529 - 17.743，p = 0.008）。然而，回归分析显示，前后径骨盆直径大于15 mm不是低分肾功能的危险因素。
超声和MAG的联合提供了必要的解剖和功能信息，以跟踪梗阻程度并决定手术干预和保守随访之间的选择。我们的研究支持严重梗阻和低分肾功能的阈值为20 mm而非15 mm）。前后径骨盆直径阈值大于15 mm在分肾功能评估中没有预测价值。
