ABSTRACT
PURPOSE: We evaluated the difference in response patterns of captopril versus standard renography for assessing hydronephrosis due to suspected ureteropelvic and ureterovesical junction obstruction. This technique may identify hydronephrotic kidneys in which normal function is maintained by vasoactive compensatory mechanisms. Sustained obstruction may cause these mechanisms to fail, and expose the kidneys to permanent functional deterioration in the long term. MATERIAL AND METHODS: We prospectively studied 15 boys and 8 girls with a mean age of 3.5 years with grades III to IV/IV hydronephrosis. Evaluations included renal sonography, standard diuretic and captopril renography, glomerular filtration rate, voiding cystography, serum creatinine, blood pressure, and urinalysis with culture and sensitivity. Obstruction was suspected at the ureteropelvic junction in 19 kidneys and at the ureterovesical junction in 9. We compared differential function values obtained by standard diuretic and captopril renography. RESULTS: We observed certain patterns in response to captopril renography, including pattern 1--unilateral decrease in hydronephrotic kidney relative function in 5 of 23 cases, 2--bilateral decreased function in 2, 3--bilateral increased function in 4 and 4--no change in function in 12 on standard renography. When half-time was more than 20 minutes on standard diuretic renography in 8 cases, captopril renography showed an ipsilateral decrease and bilateral increase in glomerular filtration rate in 4 and 1, respectively, and no change in 3. In 12 of the 23 patients (52%) there was no difference in the results of captopril and diuretic renography as well as no change in differential function on standard diuretic renography during 1 1/2 years of observation. Surgical correction was performed in 4 patients in whom half-time was greater than 20 minutes and differential function was decreased on captopril renography. CONCLUSIONS: Our preliminary study reveals that there may be a role for captopril renography for detecting renin-angiotensin system mediated compensatory mechanisms in obstructive uropathy. When such compensatory mechanisms are activated, they may be unmasked by captopril, producing 1 of 4 patterns on renography and glomerular filtration rate. Patterns may indicate different degrees of impending renal function impairment and, thus, they may become useful for determining the progression of injury, when present, and the appropriate timing of surgical intervention.
Subject(s)
Captopril , Hydronephrosis/diagnostic imaging , Kidney Pelvis , Radioisotope Renography , Ureteral Obstruction/complications , Child , Child, Preschool , Female , Humans , Hydronephrosis/etiology , Infant , Male , Predictive Value of Tests , Prospective StudiesABSTRACT
Neonatal hydronephrosis is being detected with increasing frequency. The majority of these cases have a tendency to resolve during infancy. Hydronephrosis is an anatomical entity that is not synonymous with obstruction. Review of the pathoembryology, the pathophysiology, the diagnostic techniques currently used and the natural history of hydronephrosis is given. The management and the controversies involved are discussed.
Subject(s)
Hydronephrosis/physiopathology , Hydronephrosis/therapy , Fetal Diseases/diagnosis , Humans , Hydronephrosis/diagnosis , Infant, Newborn , Prenatal DiagnosisABSTRACT
To our knowledge we report the first case of an isolated prosthetic vesico-acetabular fistula in a woman 12 years after total hip arthroplasty. Etiology, presentation, diagnosis and management are discussed.
Subject(s)
Acetabulum , Fistula/etiology , Hip Prosthesis/adverse effects , Urinary Bladder Fistula/etiology , Adult , Bone Diseases/etiology , Female , HumansABSTRACT
To our knowledge we report the first case of prenatally diagnosed bilateral neonatal torsion of the spermatic cord. Prenatal ultrasound revealed bilateral hydroceles surrounded by a second fluid layer bilaterally and bilateral inhomogeneous testicles.
