The Correlation between Serial Ultrasound and Diuretic Renography in Children with Severe Unilateral Hydronephrosis

No AccessJournal of UrologyPediatric Urology1 Aug 2018The Correlation between Serial Ultrasound and Diuretic Renography in Children with Severe Unilateral Hydronephrosis Deborah L. Jacobson, Carl C. Flink, Emilie K. Johnson, Max Maizels, Elizabeth B. Yerkes, Bruce W. Lindgren, Dennis B. Liu, Ilina Rosoklija, Earl Y. Cheng, and Edward M. Gong Deborah L. JacobsonDeborah L. Jacobson Division of Pediatric Urology, Department of Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois , Carl C. FlinkCarl C. Flink Department of Radiology, University of Cincinnati, Cincinnati, Ohio , Emilie K. JohnsonEmilie K. Johnson Division of Pediatric Urology, Department of Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois , Max MaizelsMax Maizels Division of Pediatric Urology, Department of Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois , Elizabeth B. YerkesElizabeth B. Yerkes Division of Pediatric Urology, Department of Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois , Bruce W. LindgrenBruce W. Lindgren Division of Pediatric Urology, Department of Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois , Dennis B. LiuDennis B. Liu Division of Pediatric Urology, Department of Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois , Ilina RosoklijaIlina Rosoklija Division of Pediatric Urology, Department of Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois , Earl Y. ChengEarl Y. Cheng Division of Pediatric Urology, Department of Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois , and Edward M. GongEdward M. Gong Division of Pediatric Urology, Department of Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois View All Author Informationhttps://doi.org/10.1016/j.juro.2018.03.126AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: While serial renal ultrasound is often used as an alternative to functional renal imaging in children followed for hydronephrosis, it is unclear whether a lack of hydronephrosis progression safeguards against loss of renal function. In this study we characterize the association between findings on serial renal ultrasound and diuretic renography in children with severe unilateral hydronephrosis. Materials and Methods: We retrospectively reviewed imaging among patients younger than 18 years old with a history of severe unilateral hydronephrosis, 2 renal ultrasounds and 2 diuretic renograms. Each pair of renal ultrasounds was interpreted by an independent blinded diagnostic radiologist and compared to a contemporaneous diuretic renogram. Change in hydronephrosis was considered as 1) a change in hydronephrosis grade or 2) any change by radiologist interpretation. A 5% or greater change in split differential function was considered significant. Chi-square and Spearman correlation analyses were performed. Results: A total of 85 children were evaluated. Increased hydronephrosis was noted in 11.8% of children by grade and 32.9% by radiologist interpretation. Split differential renal function worsened by 5% or more in 17.6% of children. Overall, 13.3% of children with stable or decreased hydronephrosis demonstrated worsening split differential function at an average of 11.8 months. When renal ultrasound and diuretic renograms were directly compared, the Spearman correlation was poor (r = 0.24, 95% CI 0.03 to 0.43). Conclusions: The overall correlation between imaging modalities was poor, and 13.3% of children with stable or decreased hydronephrosis had worsening of split differential renal function. These findings are important to consider when counseling nonoperatively managed children followed without diuretic renography. References 1 : Antenatal ultrasonography to detect fetal renal abnormalities: a prospective screening programme. BMJ1989; 298: 1421. Crossref, Medline, Google Scholar 2 : Fetal hydronephrosis; prevalence, natural history and postnatal consequences in an unselected population. Acta Obstet Gynecol Scand2007; 86: 1463. 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Google Scholar © 2018 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byFreedman A (2018) Prenatal Hydronephrosis—Another Swing of the Pendulum?Journal of Urology, VOL. 200, NO. 2, (256-257), Online publication date: 1-Aug-2018.Cain M (2018) This Month in Pediatric UrologyJournal of Urology, VOL. 200, NO. 2, (218-218), Online publication date: 1-Aug-2018. Volume 200Issue 2August 2018Page: 440-447 Advertisement Copyright & Permissions© 2018 by American Urological Association Education and Research, Inc.Keywordshydronephrosisradioisotope renographychildultrasonographykidneyMetricsAuthor Information Deborah L. Jacobson Division of Pediatric Urology, Department of Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois More articles by this author Carl C. Flink Department of Radiology, University of Cincinnati, Cincinnati, Ohio More articles by this author Emilie K. Johnson Division of Pediatric Urology, Department of Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois More articles by this author Max Maizels Division of Pediatric Urology, Department of Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois More articles by this author Elizabeth B. Yerkes Division of Pediatric Urology, Department of Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois More articles by this author Bruce W. Lindgren Division of Pediatric Urology, Department of Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois More articles by this author Dennis B. Liu Division of Pediatric Urology, Department of Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois More articles by this author Ilina Rosoklija Division of Pediatric Urology, Department of Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois More articles by this author Earl Y. Cheng Division of Pediatric Urology, Department of Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois More articles by this author Edward M. Gong Division of Pediatric Urology, Department of Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois More articles by this author Expand All Advertisement PDF downloadLoading ...