ABSTRACTS PRESENTADOS AL 11th INTERNATIONAL SYMPOSIUM "RADIONUCLIDES IN NEPHRO-UROLOGY", REALIZADO EN MONTEREY, CALIFORNIA, 13-17 MAYO 2001.
24. THE
VALUE OF 
MAG-3, DIURETIC RENOGRAPHY IN PREDICTING THE NEED FOR SURGERY IN THE
NEONATE WITH URETERO-PELVIC JUNCTION OBSTRUCTION.
G.N.
Sfakianakis, M.D., E.E. Vensel, M. Tapia-Palacios, R. Gosalbez, M.D.,
A.S. Labbie, M.D., G.E. Zilleruelo, M.D., C. Abitbol, M.D., B.S. Montane,
M.D.,F. Policaro.
University of Miami/Jackson Memorial Hospital, Miami,
Florida.
The
predictive value of the diuretic 
-MAG3,
scintirenography was studied prospectively in 100 neonates with sonographic
pelvicaliectasis.
Methods:
-MAG3,
was performed without bladder catheter (since all patient emptied
their bladders spontaneously) and after an iv injection of 1 mCi of
Tc-99m-Mertiatide (MAG3) followed immediately by 1 mg/kg furosemide
. Data were
acquired for 22 min followed by an image after holding the infant
upright. The morphology of the renograms and the residual of the renograms
and the residual kidney activity at 20 min (RKA) was noted. The normal
pattern was studied in over 50 neonates without hydronephrosis and
was consistent with symmetric downsloping graphs following peaking
at 2-4 min with a RKA of <50% of the peak value.
Results: A retrospective analysis of the data indicated that a total of 39 neonates remained under urologic care; of them, 20 neonates with Grade II or higher hydronephrosis by ultrasound were operated and 19 were followed until anatomy and function of the kidneys stabilized and satisfactory drainage was established. On the other hand, 61 neonates with Grade I or Grade II hydronephrosis and normal scintigraphy were discharged without need for follow up. Surgery was decided on a number of parameters (decreasing function thinning of parenchyma, deteriorating hydronephrosis including dilated calyces, condition of the contralateral kidney, etc).
Among
the 39 neonates with follow up studies, three patterns of -MAG3
results were obtained:
a) Category 1 with a downsloping renogram and 50%>RKA<80% and no significant impairment of renal function, b) Category 2 with a plateauing renogram and 80%>RKA with mild impairment of renal function, c) Category 3 with a rising renogram and moderate to severe impairment of renal function. All 15 patient in Category 1 did not required surgery. All 17 patients in Category 3 required surgery. Two patients in Category 2 required surgery, whereas two did not. In addition, earlier intervention appeared to enhance improvement of renal function whereas delay until function was lost resulted in permanent hypofunction.
Conclusion: -MAG3
, in the neonate has a predictive value for the need of surgery and
may be used to decide earlier and more effective intervention.
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