The Correlation between Serial Ultrasound and Diuretic Renography in Children with Severe Unilateral Hydronephrosis
The Correlation between Serial Ultrasound and Diuretic Renography in Children with Severe Unilateral Hydronephrosis
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DOI：
10.1016/j.juro.2018.03.126
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发表时间：
2018-08-01
影响因子：
6.6
通讯作者：
Gong, Edward M.
中科院分区：
文献类型：
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作者：
Jacobson, Deborah L.;Flink, Carl C.;Gong, Edward M.
目的：虽然连续肾脏超声通常被用作肾积水儿童肾功能成像的替代方法，但尚不清楚缺乏肾积水进展是否可以预防肾功能丧失。在这项研究中，我们的特点之间的关联，一系列肾脏超声和利尿剂肾图在儿童严重单侧hydronephalosis.Materials和方法：我们回顾性分析了18岁以下的患者的严重单侧肾积水，2肾超声和2利尿剂肾图的历史成像。每对肾脏超声检查由一名独立的盲法诊断放射科医生进行解释，并与同期的利尿肾图进行比较。肾积水的变化被认为是1）肾积水等级的变化或2）放射科医师解释的任何变化。分裂微分函数的5%或更大变化被认为是显著的。结果：共纳入85例儿童，采用χ 2检验和斯皮尔曼相关分析进行统计学处理。11.8%的儿童按级别和32.9%的放射科医生解释发现肾积水增加。在17.6%的儿童中，分裂分类肾功能恶化5%或更多。总的来说，13.3%的稳定或减轻的肾积水儿童在平均11.8个月时表现出分裂微分功能恶化。当肾脏超声和利尿剂肾图直接比较，斯皮尔曼相关性较差（r = 0.24，95%CI 0.03至0.43）。结论：影像学方式之间的整体相关性较差，13.3%的儿童稳定或减少肾积水有恶化的分裂肾功能。这些发现是很重要的考虑咨询时，非手术治疗的儿童后，没有利尿剂肾造影。
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.