Department of Pediatric Surgery, Pediatric Urology Division, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.
Department of Pediatric Surgery, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain.
BJU Int. 2019 Nov;124(5):842-848. doi: 10.1111/bju.14781. Epub 2019 May 29.
To study related factors and clinical significance of supranormal function in paediatric patients with pelvi-ureteric junction obstruction, and to predict which factors cause renal function overestimation.
Patients who underwent pyeloplasty from 2012 to 2017 were prospectively collected. Variables were compared between patients with and without supranormal function on Tc-mercaptoacetyltriglycine renal scan (supranormal defined as differential renal function [DRF] ≥55%). Univariate, multivariate logistic and linear regressions analyses were performed.
Of 100 patients, 18 were excluded because of comorbidities. Nine patients (11.5%) showed preoperative supranormal function. The preoperative anteroposterior pelvic diameter (APD; 24 mm vs 35 mm, P = 0.026) and the ratio between preoperative pelvic and kidney volumes (0.2 vs 0.6, P = 0.003) were higher in supranormal kidneys. For each unit increase in the preoperative ratio between pelvic and kidney volumes, the risk of supranormal function rose 3.23-times (95% confidence interval [CI] 1.051-9.955). A preoperative APD ≥30 mm was a reliable predictor of supranormal function (area under the curve 0.804, 95% CI 0.707-0.902), with 88.9% sensitivity. Patients with either preoperative supranormal function or preoperative APD ≥30 mm had a greater reduction in renal function after pyeloplasty.
Supranormal function is related to large hydronephrosis where geometrical features are modified. A preoperative APD ≥30 mm is a reliable predictive factor of supranormal function. Preoperative renal function is overestimated either in supranormal patients or severe hydronephrotic kidneys. DRF should be interpreted with caution in kidneys with large hydronephrosis with or without supranormal function. Surgical indication should not entirely rely upon DRF.
研究小儿肾盂输尿管交界处梗阻患者肾超功能的相关因素及临床意义，并预测哪些因素导致肾功能高估。
前瞻性收集 2012 年至 2017 年接受肾盂成形术的患者。比较 Tc-巯基乙酰三甘氨酸肾扫描（定义为肾差异功能[DRF]≥55%）存在和不存在超功能的患者之间的变量。进行单变量、多变量逻辑和线性回归分析。
100 例患者中，有 18 例因合并症而被排除。9 例（11.5%）患者术前表现为超功能。超功能肾脏的术前前后径（APD；24mm 比 35mm，P=0.026）和术前肾盂与肾脏容积比（0.2 比 0.6，P=0.003）更高。术前肾盂与肾脏容积比每增加一个单位，超功能的风险增加 3.23 倍（95%置信区间[CI] 1.051-9.955）。术前 APD≥30mm 是超功能的可靠预测指标（曲线下面积 0.804，95%CI 0.707-0.902），敏感性为 88.9%。术前存在超功能或 APD≥30mm 的患者，肾盂成形术后肾功能下降更大。
超功能与肾盂积水程度相关，其中几何特征发生改变。术前 APD≥30mm 是超功能的可靠预测因素。在超功能患者或严重肾盂积水患者中，术前肾功能被高估。DRF 应谨慎解释，尤其是在存在或不存在超功能的大肾盂积水的肾脏中。手术适应证不应完全依赖于 DRF。
