Prognostic significance of XXXX renography for managing congenital unilateral @entity3041 .

@entity1 @entity3371 @entity3041 @entity1011 @entity4145
PURPOSE: In this prospective study we evaluated the results of @entity3371 enhanced diuretic renography in @entity1 with congenital unilateral ureteropelvic junction type @entity3041 . @entity3371 renography helps to distinguish @entity1 who have renin-angiotensin system activation from those in whom it is not yet activated. Renin-angiotensin system activation heralds the beginning of compensatory vasoactive response in the kidney. Identifying grades of such activation may help in determine the end points of nonoperative management. MATERIALS AND METHODS: We prospectively studied 25 @entity1 with suspected unilateral @entity4145 treated at our department. A prenatal diagnosis was made in 60% of cases. @entity1 age was 1 to 144 months (mean 40) and the male-to-female ratio was 4:1. Followup was 6 to 72 months (mean 30). @entity1 evaluation and analysis included sonography, standard diuretic and @entity3371 renography, glomerular filtration rate, serum @entity1011 and blood pressure. The indications for surgery were symptoms, differential function below 35%, or a documented decrease of 10% or more during followup. Activation of the renin-angiotensin system was considered positive when split renal function decreased significantly by 5% or more in an obstructed system on a post- @entity3371 study. The results of @entity3371 renography were examined retrospectively in @entity1 who required surgery according to preexisting criteria. RESULTS: Society for Fetal Urology @entity3041 grade was II to IV in 8, 10 and 7 renal units, respectively. The renin-angiotensin system was activated in 8 of the 25 cases (32%) of unilateral @entity4145 . In 15 @entity1 there was no change on pre- @entity3371 and post- @entity3371 studies and in 2 split renal function on the obstructed side marginally increased on the post- @entity3371 study. Surgical correction was required in only 6 of the 8 @entity1 with renin-angiotensin system activation. Of those who required surgery @entity3041 was grades II to IV in 3, 1 and in 2 @entity1 , respectively. CONCLUSIONS: In the current study renin-angiotensin system activation correlated with the need for surgery in 75% of the cases of congenital unilateral ureteropelvic type @entity3041 . Since @entity3371 serves to identify @entity1 who have renin-angiotensin system activation, it may also be possible to grade this activation. Our preliminary results show that there may be a role for @entity3371 renography for identifying the risk group for surgical intervention.
