Shi Meihua,Jiang Dapeng,Shao Hong.Value of “supra-normal” phenomenon on ~(99)Tc~m-ethylenedicysteine diuretic renography in children with unilateral UPJO[J].Journal of Clinical Pediatric Surgery,,20():330-333,339.[doi:10.12260/lcxewkzz.2021.04.006]
Value of “supra-normal” phenomenon on ~(99)Tc~m-ethylenedicysteine diuretic renography in children with unilateral UPJO
- CLC:
- R726.9;R692.2;R692.7
- Abstract:
- Objective To explore the clinical signi? cance of "supra-normal" phenomenon for ~(99) Tc~m-ethylenedicysteine diuretic renography and predict the causative factors of renal function overestimation in children with unilateral UPJO(differential renal function DRF ≥ 55%).Methods A total of 107 children with unilateral UPJO undergoing pyeloplasty with complete clinical data from January 2014 to May 2020 were collected.They were divided into two groups of SNDRF and non-SNDRF according to with or without supra-normal function.Their clinical symptoms and imaging abnormalities were summarized.Results Among them, 14 cases showed preoperative SNDRF.The preoperative anteroposterior pelvic diameter(APD;(29.2±13.9) mm vs. (34.93±11.19) mm, P=0.035).Mean preoperative DRF was 56.5% in SNDRF group.Thus the optimal threshold point of APD for identifying supra-normal function was 26.5 mm.Conclusion Supra-normal function is correlated with expanding hydronephrosis.A preoperative APD ≥ 26.5 mm is a reliable predictor of supra-normal function.Preoperative renal function is overestimated either in SNDRF patients or severe hydronephrotic kidneys.DRF should be interpreted cautiously in kidneys with severe hydronephrosis.Surgical indication should not be dependent entirely upon DRF.
References:
1 Cho SY,Kim IS,Lee SB,et al.Nature and fate of supranormal differential renal function:lessons from long-term follow-up after pyeloplasty[J].Urology,2013,81(1):163-167.DOI:10.1016/j.urology.2012.09.017.
2 Nordenstr?m J,Koutozi G,Holmdahl G,et al.Changes in differential renal function after pyeloplasty in infants and children[J].J Pediatr Urol,2020,16(3):329.e1-e8.DOI:10.1016/j.jpurol.2020.02.002.
3 Rickard M,Braga LH,Gandhi S,et al.Comparative outcome analysis of children who underwent pyeloplasty for ureteropelvic junction obstruction associated with or without supranormal differential renal function[J].Urology,2017,99:210-214.DOI:10.1016/j.urology.2016.07.016.
4 姜大朋,史政洲,赵海腾,等.单侧肾盂输尿管连接部梗阻患儿分肾功能"超正常"现象及其临床意义[J].中华小儿外科杂志,2019,40(9):817-820.DOI:10.3760/cma.j.issn.0253-3006.2019.09.010. Jiang DP,Shi ZZ,Zhao HT,et al."Supra-normal" phenomenon of differential renal function in children with unilateral ureteropelvic junction obstruction and its clinical significance[J].Chin J Pediatri Sur,2019,40(9):817-820.DOI:10.3760/cma.j.issn.0253-3006.2019.09.010.
5 Martín-Solé O,Soria-Gondek A,Pérez-Bertólez S,et al.Value of supranormal function on 99m Tc-mercaptoacetyl triglycine renal scan in paediatric patients with obstructive hydronephrosis[J].BJU Int,2019,124(5):842-848.DOI:10.1111/bju.14781.
6 Fung LC,McLorie GA,Khoury AE,et al.Contradictory supranormal nuclear renographic differential renal function:fact or artifact[J].J Urol,1995,154(2 Pt 2):667-670.DOI:10.1097/00005392-199508000-00088.
7 Inanir S,Biyikli N,Noshari O,et al.Contradictory supranormal function in hydronephrotic kidneys:fact or artifact on pediatric MAG-3 renal scans[J].Clin Nucl Med,2005,30(2):91-96.DOI:10.1097/00003072-200502000-00004.
8 Capolicchio G,Jednak R,Dinh L,et al.Supranormal renographic differential renal function in congenital hydronephrosis:fact,not artifact[J].J Urol,1999,161(4):1290-1294.DOI:10.1016/S0022-5347(01) 61671-9.
9 Moon DH,Park YS,Jun NL,et al.Value of supranormal function and renogram patterns on 99mTc-mercaptoacetyltriglycine scintigraphy in relation to the extent of hydronephrosis for predicting ureteropelvic junction obstruction in the newborn[J].J Nucl Med,2003,44(5):725-731.
10 Pippi Salle JL,Cook A,Papanikolaou F,et al.The importance of obtaining conjugate views on renographic evaluation of large hydronephrotic kidneys:an in vitro and ex vivo analysis[J].J Urol,2008,180(4):1559-1565.DOI:10.1016/j.juro.2008.06.010.
11 Gordon I,Piepsz A,Sixt R.Auspices of Paediatric Committee of European Association of Nuclear Medicine.Guidelines for standard and diuretic renogram in children[J].Eur J Nucl Med Mol Imaging,2011,38(6):1175-1188.DOI:10.1007/s00259-011-1811-3.
12 Akta? GE,Sar?kaya A.Correction of differential renal function for asymmetric renal area ratio in unilateral hydronephrosis[J].Ann Nucl Med,2015,29(9):816-824.DOI:10.1007/s12149-015-1009-z.
13 Akta? GE,Inanir S.Relative renal function with MAG-3 and DMSA in children with unilateral hydronephrosis[J].Ann Nucl Med,2010,24(9):691-695.DOI:10.1007/s12149-010-0397-3.
14 Ham WS,Jeong HJ,Han SW,et al.Increased nephron volume is not a cause of supranormal renographic differential renal function in patients with ureteropelvic junction obstruction[J].J Urol,2004,172(3):1108-1110.DOI:10.1097/01.ju.0000135324.17766.5f.
15 Merguerian PA.Should geometric mean calculation of differential renal function be used when evaluating children with moderate to severe hydronephrosis[J].J Urol,2016,195(2):247-248.DOI:10.1016/j.juro.2015.11.003.
16 Wehbi E,Salle A,Kanaroglou N,et al.Measurement of differential renal function by scintigraphy in hydronephrotic kidneys:importance of conjugate views for accurate evaluation[J].J Urol,2016,195(2):471-475.DOI:10.1016/j.juro.2015.09.085.
Memo
收稿日期:2020-12-09。
通讯作者:邵虹,Email:shaohong@scmc.com.cn