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

Deborah L. Jacobson, Carl C. Flink, Emilie Katherine Johnson, Max Maizels, Elizabeth B Yerkes, Bruce Lindgren, Dennis B Liu, Ilina Rosoklija, Earl Y Cheng, Edward Ming-luan Gong*

*Corresponding author for this work

Research output: Contribution to journalArticle

1 Citation (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)440-447
Number of pages8
JournalJournal of Urology
Volume200
Issue number2
DOIs
StatePublished - Aug 1 2018

Fingerprint

Radioisotope Renography
Hydronephrosis
Diuretics
Kidney
Counseling

Keywords

  • child
  • hydronephrosis
  • kidney
  • radioisotope renography
  • ultrasonography

ASJC Scopus subject areas

  • Urology

Cite this

@article{70079a68db334511b1cc6b0cc4e8622a,
title = "The Correlation between Serial Ultrasound and Diuretic Renography in Children with Severe Unilateral Hydronephrosis",
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.",
keywords = "child, hydronephrosis, kidney, radioisotope renography, ultrasonography",
author = "Jacobson, {Deborah L.} and Flink, {Carl C.} and Johnson, {Emilie Katherine} and Max Maizels and Yerkes, {Elizabeth B} and Bruce Lindgren and Liu, {Dennis B} and Ilina Rosoklija and Cheng, {Earl Y} and Gong, {Edward Ming-luan}",
year = "2018",
month = "8",
day = "1",
doi = "10.1016/j.juro.2018.03.126",
language = "English (US)",
volume = "200",
pages = "440--447",
journal = "Journal of Urology",
issn = "0022-5347",
publisher = "Elsevier Inc.",
number = "2",

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TY - JOUR

T1 - The Correlation between Serial Ultrasound and Diuretic Renography in Children with Severe Unilateral Hydronephrosis

AU - Jacobson, Deborah L.

AU - Flink, Carl C.

AU - Johnson, Emilie Katherine

AU - Maizels, Max

AU - Yerkes, Elizabeth B

AU - Lindgren, Bruce

AU - Liu, Dennis B

AU - Rosoklija, Ilina

AU - Cheng, Earl Y

AU - Gong, Edward Ming-luan

PY - 2018/8/1

Y1 - 2018/8/1

N2 - 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.

AB - 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.

KW - child

KW - hydronephrosis

KW - kidney

KW - radioisotope renography

KW - ultrasonography

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