Supranormal differential renal function on MAG3 scan in children with ureteropelvic junction obstruction - Prevalence and pyeloplasty during follow-up
Värelä, Sanni LU ; Jakobsson, Christoffer ; Persson, Eva LU ; Börjesson, Anna LU ; Hagander, Lars LU
and Salö, Martin
LU
(2023)
In Journal of Pediatric Urology
19(6).
p.1-778
- Abstract
BACKGROUND: Children with suspected ureteropelvic junction obstruction (UPJO) may present with a paradoxical ipsilateral supranormal differential renal function (snDRF) on
99mTechnetium mercaptoacetyltriglycine scintigraphy (MAG3 scan).
OBJECTIVE: The aim was to investigate the prevalence of snDRF, the risk of pyeloplasty among children with UPJO and snDRF, and to explore the experience of snDRF among international pediatric urologists.
METHODS: A retrospective cohort study of children with suspected unilateral UPJO who underwent MAG3 scan at four hospitals in Sweden between 2005 and 2020. SnDRF was defined as DRF ≥55%. Normal DRF was defined as DRF 45-54%. Primary outcome was risk of pyeloplasty. Indications for... (More)
BACKGROUND: Children with suspected ureteropelvic junction obstruction (UPJO) may present with a paradoxical ipsilateral supranormal differential renal function (snDRF) on
99mTechnetium mercaptoacetyltriglycine scintigraphy (MAG3 scan).
OBJECTIVE: The aim was to investigate the prevalence of snDRF, the risk of pyeloplasty among children with UPJO and snDRF, and to explore the experience of snDRF among international pediatric urologists.
METHODS: A retrospective cohort study of children with suspected unilateral UPJO who underwent MAG3 scan at four hospitals in Sweden between 2005 and 2020. SnDRF was defined as DRF ≥55%. Normal DRF was defined as DRF 45-54%. Primary outcome was risk of pyeloplasty. Indications for pyeloplasty were loss of >10%-points of differential renal function (DRF), ipsilateral DRF <40%, or symptomatic UPJO. Logistic and cox regressions were performed in univariate and multivariable analyses, adjusting for age, gender, year, laterality, antenatal hydronephrosis, anterior-posterior diameter (APD), and kidney size. An international questionnaire regarding the management of snDRF was developed and distributed to pediatric urologists.
RESULTS: The prevalence of snDRF was 19%. SnDRF was more common in boys, children with antenatal hydronephrosis, children undergoing their first MAG3 scan at a younger age, and in the left kidney. After further exclusion of 70 children with DRF <45%, a total of 264 were included for longitudinal follow-up of median 6.6 (IQR 2.5-11.5) years. SnDRF was not associated with increased risk of pyeloplasty (adjusted OR 0.98 (95% CI 0.41-2.33), p = 0.96, and adjusted HR 1.00 (95% CI 0.53-1.91), p = 0.99) or time to pyeloplasty (1.1 years vs. 1.6 years, p = 0.40). Among the 79 surveyed pediatric urologists, a majority would not change clinical UPJO-management based on the presence or absence of ipsilateral snDRF.
DISCUSSION: There are only a few studies considering the need of pyeloplasty based on the presence of snDRF and this is the first survey among pediatric urologists on its management. With more included patients than previous studies, this study showed a snDRF prevalence of 19%, congruent with the findings of others. The underlying cause of snDRF is debated, but it cannot solely be explained as an artifact of hydronephrotic kidneys. Further studies on the clinical implications of snDRF are warranted, since DRF influences the decision to operate.
CONCLUSION: A fifth of all children with suspected UPJO presented with ipsilateral snDRF on initial MAG3 scan, and snDRF was not associated with a greater risk of pyeloplasty. Supported by a large group of international pediatric urology colleagues, this study concludes that the same clinical follow-up and management apply, regardless of presence of snDRF.
(Less)
- author
- Värelä, Sanni
LU
; Jakobsson, Christoffer
; Persson, Eva
LU
; Börjesson, Anna
LU
; Hagander, Lars
LU
and Salö, Martin
LU
- organization
- publishing date
- 2023-08-18
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Journal of Pediatric Urology
- volume
- 19
- issue
- 6
- pages
- 1 - 778
- publisher
- Elsevier
- external identifiers
-
- scopus:85172884407
- pmid:37726189
- ISSN
- 1477-5131
- DOI
- 10.1016/j.jpurol.2023.08.006
- language
- English
- LU publication?
- yes
- additional info
- Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.
- id
- 2fd0bc42-3436-499d-96ac-a8b86a3f5074
- date added to LUP
- 2023-10-14 12:51:49
- date last changed
- 2024-04-19 02:21:04
@article{2fd0bc42-3436-499d-96ac-a8b86a3f5074,
abstract = {{<p>BACKGROUND: Children with suspected ureteropelvic junction obstruction (UPJO) may present with a paradoxical ipsilateral supranormal differential renal function (snDRF) on<br>
99mTechnetium mercaptoacetyltriglycine scintigraphy (MAG3 scan).<br>
</p><p>OBJECTIVE: The aim was to investigate the prevalence of snDRF, the risk of pyeloplasty among children with UPJO and snDRF, and to explore the experience of snDRF among international pediatric urologists.</p><p>METHODS: A retrospective cohort study of children with suspected unilateral UPJO who underwent MAG3 scan at four hospitals in Sweden between 2005 and 2020. SnDRF was defined as DRF ≥55%. Normal DRF was defined as DRF 45-54%. Primary outcome was risk of pyeloplasty. Indications for pyeloplasty were loss of >10%-points of differential renal function (DRF), ipsilateral DRF <40%, or symptomatic UPJO. Logistic and cox regressions were performed in univariate and multivariable analyses, adjusting for age, gender, year, laterality, antenatal hydronephrosis, anterior-posterior diameter (APD), and kidney size. An international questionnaire regarding the management of snDRF was developed and distributed to pediatric urologists.</p><p>RESULTS: The prevalence of snDRF was 19%. SnDRF was more common in boys, children with antenatal hydronephrosis, children undergoing their first MAG3 scan at a younger age, and in the left kidney. After further exclusion of 70 children with DRF <45%, a total of 264 were included for longitudinal follow-up of median 6.6 (IQR 2.5-11.5) years. SnDRF was not associated with increased risk of pyeloplasty (adjusted OR 0.98 (95% CI 0.41-2.33), p = 0.96, and adjusted HR 1.00 (95% CI 0.53-1.91), p = 0.99) or time to pyeloplasty (1.1 years vs. 1.6 years, p = 0.40). Among the 79 surveyed pediatric urologists, a majority would not change clinical UPJO-management based on the presence or absence of ipsilateral snDRF.</p><p>DISCUSSION: There are only a few studies considering the need of pyeloplasty based on the presence of snDRF and this is the first survey among pediatric urologists on its management. With more included patients than previous studies, this study showed a snDRF prevalence of 19%, congruent with the findings of others. The underlying cause of snDRF is debated, but it cannot solely be explained as an artifact of hydronephrotic kidneys. Further studies on the clinical implications of snDRF are warranted, since DRF influences the decision to operate.</p><p>CONCLUSION: A fifth of all children with suspected UPJO presented with ipsilateral snDRF on initial MAG3 scan, and snDRF was not associated with a greater risk of pyeloplasty. Supported by a large group of international pediatric urology colleagues, this study concludes that the same clinical follow-up and management apply, regardless of presence of snDRF.</p>}},
author = {{Värelä, Sanni and Jakobsson, Christoffer and Persson, Eva and Börjesson, Anna and Hagander, Lars and Salö, Martin}},
issn = {{1477-5131}},
language = {{eng}},
month = {{08}},
number = {{6}},
pages = {{1--778}},
publisher = {{Elsevier}},
series = {{Journal of Pediatric Urology}},
title = {{Supranormal differential renal function on MAG3 scan in children with ureteropelvic junction obstruction - Prevalence and pyeloplasty during follow-up}},
url = {{http://dx.doi.org/10.1016/j.jpurol.2023.08.006}},
doi = {{10.1016/j.jpurol.2023.08.006}},
volume = {{19}},
year = {{2023}},
}