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KMID : 1218220090010010021
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Korean Journal of Pediatric Urology
2009 Volume.1 No. 1 p.21 ~ p.30
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Radioisotope Study in the Management of Hydronephrosis
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Kim In-Ju
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Abstract
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Hydronephrosis is defined as a dilatation of the pelvocalyceal system and has an estimated incidence of 1 in 600 infants. To decide whether neonatal hydronephrosis can be managed non-operatively or require surgical intervention is still a challenge. Of nuclear medicine tests, diuretic renography using Tc-99m MAG3 is useful to differentiate progressive hydronephrosis requiring surgical intervention from transient hydronephrosis. Diuretics cause increased urinary flow which promotes a prompt washout in non-obstructive hydronephrosis. An obstructed system will not respond to diuretics, so radioactivity will accumulate continuously and in renogram the curve will rise constantly or show plateau occasionally. In general, the T1/2 is used as an indicator of obstruction even though it is not confirmative - greater than 20 minutes means obstruction whereas less than 15 minutes indicates no obstruction. A split renal function of 45-55% is considered to be within normal range and it is decreased abnormally in obstruction. Diuretic renography is noninvasive and can quantify parameters about renal function, such as T1/2 and split renal function, therefore it is very useful clinical tool in the diagnosis and management of hydronephrosis and other pediatric urologic diseases.
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KEYWORD
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Diuretic renography, Hydronephrosis, Split renal function, Tc-99m MAG3
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