Suman Bijay Kumar, Manekar Aditya Arvind, Sahoo Subrat Kumar, Agrawal Kanhaiyalal, Tripathy Bikasha Bihary, Mohanty Manoj Kumar
Department of Pediatric Surgery, AIIMS, Rishikesh, Uttarakhand, India.
Department of Pediatric Surgery, AIIMS, Bhubaneswar, Odisha, India.
J Indian Assoc Pediatr Surg. 2025 Jul-Aug;30(4):519-525. doi: 10.4103/jiaps.jiaps_12_25. Epub 2025 Jul 4.
Ureteropelvic junction obstruction (UPJO) is the most common cause of antenatal hydronephrosis. Although the majority of them improve with time, none of the existing diagnostic modalities can accurately predict which hydronephrotic kidney is at the risk of progressive renal damage and will benefit from early surgery. Few authors have suggested that a delayed cortical transit time (CTT) on diuretic renography is a reliable prognostic factor for both the need for surgery and renal functional improvement after surgery.
We designed this prospective observational study on CTT in Tc-EC renal scan of all the unilateral UPJO patients of mean age were 2.15 years (0-5 years) managed in our institute. All patients diagnosed antenatally or postnatally with unilateral hydronephrosis, possibly due to UPJO, were evaluated and investigated. Tc-EC renogram was done. The detailed data were collected on CTT, differential renal function, the drainage pattern, and other parameters measured in a diuretic renogram. The management of these patients was done as per the standard institutional protocol, and there was no deviation due to inclusion in this study. Linear correlation between two continuous variables was explored using Pearson's correlation (if the data were normally distributed) and Spearman's correlation (for nonnormally distributed data).
We found a CTT of more than 210 s to be associated with a 95% sensitivity and 74% specificity for the requirement of surgery in children with unilateral UPJO. The limitation of our study was the small sample size ( = 36). However, a multicentric study with a large sample size may confirm our findings.
The predictive value of CTT as a reliable and sensitive indicator of surgery and early recovery even after 3 months of surgery. CTT can be used to identify reliably those subset of patients with unilateral UPJO who will deteriorate irreversibly. We are proposing the cutoff value of CTT to be 210 s, unlike several previous researchers, who have found a cutoff value of 180 to be significant.
肾盂输尿管连接处梗阻（UPJO）是产前肾积水最常见的原因。尽管大多数病例会随时间改善，但现有的诊断方法均无法准确预测哪个肾积水肾脏有进行性肾损害的风险，以及哪些患者将从早期手术中获益。少数作者提出，利尿肾图上皮质转运时间（CTT）延迟是手术必要性及术后肾功能改善的可靠预后因素。
我们针对本院收治的平均年龄为2.15岁（0至5岁）的所有单侧UPJO患者，设计了一项关于Tc-EC肾扫描中CTT的前瞻性观察性研究。对所有产前或产后诊断为单侧肾积水（可能由UPJO引起）的患者进行评估和检查。进行了Tc-EC肾图检查。收集了关于CTT、分肾功能、引流模式以及利尿肾图中测量的其他参数的详细数据。这些患者按照标准的机构方案进行管理，且未因纳入本研究而出现偏差。使用Pearson相关性分析（如果数据呈正态分布）和Spearman相关性分析（对于非正态分布的数据）来探索两个连续变量之间的线性相关性。
我们发现，对于单侧UPJO患儿，CTT超过210秒与手术需求的敏感性为95%、特异性为74%相关。本研究的局限性在于样本量小（n = 36）。然而，一项大样本的多中心研究可能会证实我们的发现。
CTT作为手术及术后3个月即使早期恢复的可靠且敏感指标具有预测价值。CTT可用于可靠地识别单侧UPJO患者中那些将发生不可逆恶化的亚组。我们建议CTT的临界值为210秒，与之前几位研究人员发现的180秒具有显著意义的临界值不同。
