Comparison of two drainage parameters on diuretic renogram in predicting the fate of prenatally detected pelvi-ureteric junction-like obstruction.

Introduction: In infants with suspected pelviureteric junction (PUJ) like obstruction, we compared the drainage patterns suggested by t 1/2 and normalized residual activity (NORA) to determine which parameter can differentiate obstructive from nonobstructive dilatation and thus predict the need for surgery.

Materials And Methods: Infants presenting with prenatally detected PUJ-like obstruction from January 2014 to March 2020 were evaluated with ultrasonography. Diuretic renogram was performed using Tc99m ethylene dicysteine using the F0 protocol. Subjects with a differential renal function >40% were included in the study. The t ½ values were noted. NORA was calculated by dividing the tracer values at 60 min with the values at 2 min. The infants were followed using ultrasonography. Renogram was repeated if there was increase in hydronephrosis or after 6 months if hydronephrosis did not regress. The follow-up was continued till a decision for pyeloplasty was made or the hydronephrosis regressed. Pyeloplasty was advised if differential function dropped to below 40%.

Results: 34 patients met the inclusion criteria. NORA and t ½ had very poor concordance in defining the drainage pattern. t ½ values did not correlate with the need for surgery or conservative management ( ≥ 0.05). Good drainage pattern by NORA was associated with regression of hydronephrosis ( ≤ 0.001). NORA predicted obstruction more accurately.

Conclusion: NORA can define good drainage in a much larger subset of patients with PUJ-like obstruction who eventually do not need surgery. However, further multicenter studies are needed to confirm this.