Evaluation of Differential Renal Function and Renographic Patterns in Patients with Dietl Crisis
| Autor: | H. Gil Rushton, Scott Sparks, Hans G. Pohl, Massoud Majd, Bernarda Viteri, Bruce M. Sprague |
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| Rok vydání: | 2013 |
| Předmět: |
Male
medicine.medical_specialty Pyeloplasty Adolescent Vomiting Urology medicine.medical_treatment Ureteropelvic junction Kidney Preoperative care Young Adult Preoperative Care medicine Humans Kidney Pelvis In patient Child Hydronephrosis Retrospective Studies Postoperative Care Differential renal function medicine.diagnostic_test business.industry Radioisotope renography Nausea Retrospective cohort study medicine.disease Abdominal Pain medicine.anatomical_structure Child Preschool Female Radiology business Radioisotope Renography Ureteral Obstruction |
| Zdroj: | Journal of Urology. 189:684-689 |
| ISSN: | 1527-3792 0022-5347 |
| Popis: | We analyzed preoperative and postoperative differential renal function and characterized the renographic findings in patients with ureteropelvic junction obstruction associated with Dietl crisis.Patients with Dietl crisis who underwent pyeloplasty between January 2004 and December 2010 were classified by renographic presentation. Patients in group 1 were diagnosed with cortical retention, those in group 2 had an initial obstructed scan (T1/2 of 20 minutes or more and no cortical retention) and those in group 3 had an initial nondiagnostic scan (T1/2 of less than 20 minutes and no cortical retention). Renographic parameters were used to analyze each group.A total of 59 patients met criteria for study inclusion. The 13 patients in group 1 demonstrated the most significant recovery of function after pyeloplasty (mean differential renal function change 13.59%). The 38 patients in group 2 exhibited a mean differential renal function change of 43.06% (range 20% to 54.6%) and mean preoperative T1/2 of 64.31 minutes. Pyeloplasty was performed in all 8 patients in group 3 based on subsequent diagnostic scan (4 patients) or increased hydronephrosis on other imaging associated with further symptomatic episodes (4). Initial renographic patterns noted in group 3 included biphasic curves, diminished clearance after 15 minutes upright or symptoms despite nonobstructive drainage.Interpretation of diuretic renography requires the assimilation of multiple parameters since patients with Dietl crisis can exhibit variability in renographic patterns due to the intermittent nature of ureteropelvic junction obstruction. Cortical retention represents a specific and pathognomic finding of acute ureteropelvic junction obstruction. With appropriate evaluation of these parameters, obstruction can be reliably diagnosed and appropriate surgical candidates chosen. |
| Databáze: | OpenAIRE |
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