Chung S, Majd M, Rushton H G, Belman A B
Department of Radiology, Children's National Medical Center, Washington, D.C. 20010.
J Urol. 1993 Aug;150(2 Pt 2):765-8. doi: 10.1016/s0022-5347(17)35609-4.
Arguments against the use of diuretic renography in the assessment of newborn hydronephrosis include immature function of neonatal kidneys, previously reported poor diuretic response and nonreproducible drainage patterns. To address these concerns we reviewed the initial and followup renal scans of 17 neonates with hydronephrosis without ureterectasis diagnosed by perinatal ultrasonography. All patients were evaluated with an initial diuretic renal scan up to the age of 28 days, and all had normal cystograms. A total of 19 dilated kidneys was studied of which 13 ultimately required pyeloplasty and 6 were managed nonsurgically. Patient study parameters included age and weight at the time of each renal scan, side of hydronephrosis, differential function of each kidney, pre-diuretic and post-diuretic urine output, and drainage half-time of each kidney. The diuretic renal scans followed a standardized protocol. There was no statistically significant difference between neonatal and followup differential function (p > 0.05), and the correlation coefficient was highly significant (r = 0.968). Comparison of response to diuretic stimulation (ml./kg. per minute) revealed no statistically significant difference as the patients aged with brisk urine output 3 to 5 times greater than previously reported. The distribution and mean drainage half-times for normal nonhydronephrotic kidneys were similar when comparing those performed as neonates and at followup. Hydronephrotic kidneys managed nonsurgically maintained almost identical patterns. Those repaired surgically demonstrated appropriate improvement in drainage but function remained unchanged. These results refute each of the criticisms against the use of diuretic renography to evaluate neonatal hydronephrosis and demonstrate its reliability in neonates.
反对在评估新生儿肾积水时使用利尿肾造影的理由包括新生儿肾脏功能不成熟、先前报道的利尿反应不佳以及引流模式不可重复。为了解决这些问题，我们回顾了17例经围产期超声诊断为肾积水但无输尿管扩张的新生儿的初始和随访肾脏扫描结果。所有患者在28天龄时均接受了初始利尿肾扫描评估，且所有患者的膀胱造影均正常。共研究了19个扩张的肾脏，其中13个最终需要进行肾盂成形术，6个采用非手术治疗。患者研究参数包括每次肾脏扫描时的年龄和体重、肾积水的侧别、每个肾脏的分肾功能、利尿前和利尿后的尿量以及每个肾脏的引流半衰期。利尿肾扫描遵循标准化方案。新生儿和随访时的分肾功能之间无统计学显著差异（p>0.05），且相关系数高度显著（r=0.968）。对利尿刺激反应（毫升/千克每分钟）的比较显示，随着患者年龄增长，尿量迅速增加，是先前报道的3至5倍，差异无统计学意义。比较新生儿期和随访时正常无肾积水肾脏的分布和平均引流半衰期，结果相似。非手术治疗的肾积水肾脏维持了几乎相同的模式。手术修复的肾脏在引流方面有适当改善，但功能保持不变。这些结果反驳了反对使用利尿肾造影评估新生儿肾积水的每一项批评，并证明了其在新生儿中的可靠性。
