ABSTRACTS PRESENTADOS AL 11th INTERNATIONAL SYMPOSIUM "RADIONUCLIDES IN NEPHRO-UROLOGY", REALIZADO EN MONTEREY, CALIFORNIA, 13-17 MAYO 2001.

Jitendra. S Shekhwat, A. Maini, M. Bajpal, G.S Pant, R. Kumar, A. Malhotra.
All India Institute of Medical Sciences, New Delhi, India.

Management of antenatally diagnosed hydronephrosis is controversial. Conservative follow up is favored by most surgeons unless the differential function falls below 35-40%. Activation of compensatory mechanisms like renin-angiotensin system is found in these cases. It may be important to identify the time when decompensation starts since after operation it is often seen that there is no improvement in function of the kidney. This can be detected by captopril renography (CR).

The aim of this ongoing prospective study is to evaluate the utility of diuretic captopril renography in congenital hydronephrosis.

Eighteen patients with antenatally diagnosed unilateral hydronephrosis (age range: 2 months-6 years, median 3 months) and five patients ( age range: 4 months-3 years, median 6 months) with bilateral hydronephrosis underwent diuretic renography with Tc99m-DTPA 60 minutes after oral administration of captopril (0.5 mg/kg). A baseline study was performed within 3 days under same conditions. Split renal function and global GFR by two plasma sample method was calculated in each patient. CR was positive if there was a significant change in differential function or if global GFR decreased significantly. CR was positive in three cases with unilateral PUJO and in two patients with bilateral PUJO. Two of the patients with positive CR (one with bilateral and another with unilateral PUJO) underwent pyeloplasty after which renal function was seen to improve.

Conclusion: The preliminary results from this study suggest a possible role for captopril renography in the follow up and prognostic stratification of patients with antenatally diagnosed PUJO with the purpose of enabling timely surgical intervention and hence better post operative outcome.