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Prediction of Clinical Outcomes in Prenatal Hydronephrosis: Importance of Gravity Assisted Drainage

Published on Mar 1, 2017in The Journal of Urology5.647
· DOI :10.1016/j.juro.2016.09.111
Rachael D. Sussman2
Estimated H-index: 2
(MedStar Georgetown University Hospital),
Emily S. Blum2
Estimated H-index: 2
+ 3 AuthorsHans G. Pohl6
Estimated H-index: 6
Abstract
Purpose: In infants with SFU (Society for Fetal Urology) grade 3-4 congenital hydronephrosis, 99mTc-mercaptoacetyltriglycine diuretic renography assesses differential function and drainage half-time. We routinely also include the percent of radiotracer drained after 30 minutes of diuresis as well as after 15 minutes with the patient in the upright position. We investigated whether any 1 or more of these parameters on initial diuretic renography predicts persistent or worsening drainage parameters.Materials and Methods: Infants 6 months or younger with grade 3-4 congenital hydronephrosis who presented between January 2009 and December 2014 were identified from billing data and included in analysis if they underwent at least 1 baseline diuretic renography. Those with structural anomalies were excluded from study. Baseline and followup differential function, diuresis half-time, clearance at 30 minutes and clearance with the patient upright were abstracted and comparisons were made between those with initiall...
  • References (11)
  • Citations (3)
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References11
Newest
#1Dennis B. Liu (NU: Northwestern University)H-Index: 10
#2William R. Armstrong (UIC: University of Illinois at Chicago)H-Index: 1
Last. Max Maizels (NU: Northwestern University)H-Index: 11
view all 3 authors...
Antenatal hydronephrosis (ANH) is one of the most frequently detected abnormalities found on routine prenatal ultrasounds, affecting 1% to 4.5% of all pregnancies. Despite its prevalence, there continues to be uncertainty regarding the clinical impact after birth. Prognosis depends on the severity of the dilation. Expectant prenatal management is the rule with fetal intervention rarely needed in a few select cases. Ureteropelvic junction obstruction and vesicoureteral reflux are the most common ...
25 CitationsSource
#1Matthew D. Timberlake (Department of Urology, University of Virginia)H-Index: 8
#2C.D. Anthony Herndon (Department of Urology, University of Virginia)H-Index: 17
No universal guidelines exist for the management of patients with mild to moderate antenatal hydronephrosis (ANH). In this Review, the authors assess the data and present their own approach to postnatal risk stratification and management, including recommendations regarding serial ultrasonography schedule, prophylactic antibiotics, voiding cystourethrogram and renal scintigraphy.
14 CitationsSource
#1Sherry S. Ross (Children's National Medical Center)H-Index: 11
#2Steve Kardos (Children's National Medical Center)H-Index: 1
Last. H. Gil Rushton (Children's National Medical Center)H-Index: 21
view all 10 authors...
Abstract Purpose Early pyeloplasty is indicated for ureteropelvic junction obstruction (UPJ) obstructions with reduced differential renal function (DRF) and/or no drainage on diuretic renography (DR). Optimal management of Society of Fetal Urology (SFU) Grades 3 and 4hydronephrosis with preservation of DRF and indeterminate drainage is less straightforward. We review our experience using serial DR to guide the management of kidneys with high-grade hydronephrosis, emphasizing preservation of DRF....
32 CitationsSource
#1Amnon PiepszH-Index: 25
Last. Hamphrey HamH-Index: 19
view all 4 authors...
The objectives of this study were 2-fold: first, to investigate the robustness of the normalized residual activity (NORA), a parameter that has recently been proposed for the estimation of renal emptying during renography; and second, to define the usual values of NORA in 2 categories of kidneys-those with a normal renogram and those that are dilated but definitely unobstructed. Methods: NORA was defined as the renal activity at a given moment (end of renogram, end of furosemide acquisition, ima...
34 Citations
#1Leonard P. Connolly (Harvard University)H-Index: 22
#2David Zurakowski (Harvard University)H-Index: 100
Last. Salvador Treves (Harvard University)H-Index: 47
view all 8 authors...
Purpose: We assessed variability in the interpretation of diuresis renography that may result from using different methods of clearance half-time determination.Materials and Methods: We reviewed 152 diuresis renography studies performed at diagnosis or during followup of 53 children enrolled in a prospective study assessing the natural history of unilateral neonatal hydronephrosis. Studies were classified as nonobstructive, indeterminate or obstructive using 4 methods of half-time determination....
27 CitationsSource
UNLABELLED: The aim of this study was to evaluate the use of quantitative gravity-assisted drainage (GAD) using >50% residual activity as an indicator to confirm obstruction in diuretic renography in the investigation of hydronephrosis and hydroureteronephrosis in infants and children. This was evaluated in 2 groups: furosemide clearance half-time (t 1/2) > 20 min (obstructed range) and t 1/2 = 10-20 min (indeterminate range). METHODS: Two hundred children (155 boys, 45 girls; age range, 2 d to ...
42 Citations
The clinical performance of a laboratory test can be described in terms of diagnostic accuracy, or the ability to correctly classify subjects into clinically relevant subgroups. Diagnostic accuracy refers to the quality of the information provided by the classification device and should be distinguished from the usefulness, or actual practical value, of the information. Receiver-operating characteristic (ROC) plots provide a pure index of accuracy by demonstrating the limits of a test's ability ...
4,898 Citations
#1James J. Conway (NU: Northwestern University)H-Index: 13
Differentiating the various causes of hydronephrosis from that of obstruction can be very difficult. Diuretic renography has been adopted as a noninvasive clinical management tool to assist in this differentiation. However, the correlation of the results of diuresis renography, the Whitaker test, and the surgical results has only been between 40% and 85%. This is believed to be due to the many physiological factors and technical pitfalls of the technique. These include variable renal function, v...
112 CitationsSource
#1James J. Conway (Children's Memorial Hospital)H-Index: 16
#2Maizels MH-Index: 1
: Perinatal hydronephrosis (HN) and hydroureteronephrosis (HUN) are recognized more frequently as the routine use of prenatal ultrasonography increases. The decision-making process for those instances of urinary tract dilatation that require surgical correction and those that do not is based in part on the findings of diuresis renography. The methodology for performing this test has differed among nuclear medicine practitioners and the surgical findings are occasionally discrepant from the diure...
218 Citations
#1Elizabeth R. DeLong (IQVIA: Quintiles)H-Index: 60
#2David M. DeLong (IQVIA: Quintiles)H-Index: 51
Last. Daniel L. Clarke-PearsonH-Index: 52
view all 3 authors...
Abstract Methods of evaluating and comparing the performance of diagnostic tests are of increasing importance as new tests are developed and marketed. When a test is based on an observed variable that lies on a continuous or graded scale, an assessment of the overall value of the test can be made through the use of a receiver operating characteristic (ROC) curve. The curve is constructed by varying the cutpoint used to determine which values of the observed variable will be considered abnormal a...
9,572 CitationsSource
Cited By3
Newest
#1Christopher E. Bayne (UF: University of Florida)
Last. H.G. RushtonH-Index: 6
view all 3 authors...
Summary Diuresis renography (DR) is widely used in the evaluation of hydronephrosis and hydroureter in infants and children. The goal of this provocative nuclear imaging examination should be to detect the hydronephrotic kidneys at risk for loss of function and development of pain, hematuria, and urinary tract infection. The reliability of DR is dependent on the acquisition and processing of the data as well as interpretation and utilization of the results. In this review, the key concepts of st...
Source
#1Andrea Balthazar (VCU: Virginia Commonwealth University)
#2C.D. Anthony Herndon (VCU: Virginia Commonwealth University)H-Index: 17
: Urinary tract dilatation (UTD) is the most common congenital anomaly detected on prenatal ultrasonography (US), affecting 1% to 3% of all pregnancies. This article focuses on the prenatal detection of UTD and the postnatal evaluation and management based on the UTD grading system risk assessment. Prophylactic antibiotics and postnatal imaging are discussed. The recent management trend is for a more conservative approach to minimize unnecessary testing and exposures to the fetus and neonate whi...
Source
#1Emily S. BlumH-Index: 1
#2Antonio R. PorrasH-Index: 7
Last. Marius George Linguraru (GW: George Washington University)H-Index: 17
view all 10 authors...
2 CitationsSource