Mp72-18 the Conundrum of High-Grade Hydronephrosis With Indeterminate Lasix Renal Scan

You have accessJournal of UrologyPediatrics VII (MP72)1 May 2024MP72-18 THE CONUNDRUM OF HIGH-GRADE HYDRONEPHROSIS WITH INDETERMINATE LASIX RENAL SCAN Elias J. Wehbi, Sarah H. Williamson, Carol A. Davis-Dao, C. D. Anthony Herndon, Joshua D. Chamberlin, Anne G. Dudley, Shannon Cannon, Gina M. Lockwood, Nora G. Kern, Rebecca S. Zee, Luis H. Braga, Valre W. Welch, Kai-Wen Chuang, Melissa McGrath, Heidi A. Stephany, and Antoine E. Khoury Elias J. WehbiElias J. Wehbi , Sarah H. WilliamsonSarah H. Williamson , Carol A. Davis-DaoCarol A. Davis-Dao , C. D. Anthony HerndonC. D. Anthony Herndon , Joshua D. ChamberlinJoshua D. Chamberlin , Anne G. DudleyAnne G. Dudley , Shannon CannonShannon Cannon , Gina M. LockwoodGina M. Lockwood , Nora G. KernNora G. Kern , Rebecca S. ZeeRebecca S. Zee , Luis H. BragaLuis H. Braga , Valre W. WelchValre W. Welch , Kai-Wen ChuangKai-Wen Chuang , Melissa McGrathMelissa McGrath , Heidi A. StephanyHeidi A. Stephany , and Antoine E. KhouryAntoine E. Khoury View All Author Informationhttps://doi.org/10.1097/01.JU.0001009572.60675.69.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In patients with high grade hydronephrosis (HN), reassuring findings on diuretic renography (MAG-3) can pose a dilemma for clinicians. Some patients may progress and require pyeloplasty, however little is known about this group. We aimed to investigate the outcomes of patients with high grade HN with seemingly normal or indeterminate obstruction on MAG-3. METHODS: Patients with prenatally detected isolated HN were prospectively enrolled from 7 centers from 2007-2022. Included patients had a MAG-3 with T ½ time 10% on RBUS after MAG-3. Patients were classified as 1) Progression or 2) Stable/Improved. Wilcoxon two-sample tests were used for comparison. RESULTS: Of 379 patients with MAG-3, 129 met inclusion criteria. Median age at MAG-3 was 3.1 months and 77% were male. Forty-six percent (59/129) had a follow-up MAG-3. Of those, 29/59 (49%) had progression on MAG-3. On subsequent MAG-3, in the group who progressed, the median decrease in differential function was 9% and median increase in T ½ time was 22 mins. Among patients with repeat RBUS, 40% (59/129) had worsening of APD >10% after initial MAG-3. There was no difference in median APD at the initial RBUS between the progression and stable groups (13mm vs 12mm; p=0.95, respectively). In those patients with progression defined by worsening APD, the median percentage increase in APD was 21% (IQR 12% to 36%), while the median percentage change in the stable group was a decrease in APD by -47% (IQR -67% to -6.0%).In all, 53% (69/129) of patients progressed after a first MAG-3 scan with T ½ time <20 minutes, while 60 patients were stable or improved. Among the progression group, the median age at initial MAG-3 was significantly younger than in the stable group (2.8 months versus 3.9 months, respectively, p=0.03). CONCLUSIONS: Patients with higher grades of hydronephrosis and reassuring MAG-3 can pose a significant challenge to clinical management. In our study, 53% progressed on subsequent MAG-3 or RBUS. Caution should be exercised in these patients, particularly those under 3 months old, as over half may progress and require intervention. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1179 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Elias J. Wehbi More articles by this author Sarah H. Williamson More articles by this author Carol A. Davis-Dao More articles by this author C. D. Anthony Herndon More articles by this author Joshua D. Chamberlin More articles by this author Anne G. Dudley More articles by this author Shannon Cannon More articles by this author Gina M. Lockwood More articles by this author Nora G. Kern More articles by this author Rebecca S. Zee More articles by this author Luis H. Braga More articles by this author Valre W. Welch More articles by this author Kai-Wen Chuang More articles by this author Melissa McGrath More articles by this author Heidi A. Stephany More articles by this author Antoine E. Khoury More articles by this author Expand All Advertisement PDF downloadLoading ...