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The following is a summary of “Utility of F-15 diuretic MAG3 renography in the assessment of pediatric hydronephrosis,” published in the March 2024 issue of Pediatrics by Roy et al.

This study aimed to investigate the utility of F-15 renograms in children with hydronephrosis undergoing assessment for Pelvi–Ureteric Junction Obstruction (PUJO).

Diuretic renography is critical in evaluating pediatric hydronephrosis, particularly in suspected upper urinary tract obstruction cases. While the conventional approach involves administering furosemide 15-20 minutes after radiolabelled tracer injection (F+15/F+20 protocol), this method yields equivocal results in approximately 15% of patients. An alternative approach, giving furosemide 15 minutes before tracer injection (F-15 MAG3 protocol), has been proposed as an adjunctive tool in assessing such patients. However, its specific utility in pediatric hydronephrosis assessment still needs to be explored.

A retrospective review was conducted of patients under 16 years old who underwent F-15 MAG3 renography between 2018 and 2021 at the tertiary pediatric surgical center. Data collected included patient demographics, presentation mode, investigations, management strategies, and outcomes.

About 18 patients were included, with a median age of 7.3 years at the time of F-15 renogram. The majority presented with antenatal hydronephrosis or childhood symptoms, while some had incidental findings on trauma imaging. Most symptomatic patients had inconclusive prior F+20 renograms. Of the 18 patients, 16 (89%) had conclusive F-15 renograms, with 11 showing obstruction and 5 non-obstruction. All symptomatic patients had conclusive scans.

While conventional F+20 MAG3 renograms may yield equivocal results, F-15 renograms usually provide conclusive outcomes. Although routine primary use is discouraged due to potential overdiagnosis of obstruction, F-15 renograms serve as a valuable adjunct in patients with symptoms suggestive of PUJO and previous equivocal or non-obstructed F+20 renograms.

F-15 renograms were conclusive in 89% of cases and helpful in aiding surgical decision-making, especially in patients with equivocal F+20 renograms and symptoms suggestive of PUJO. This study underscores the potential utility of F-15 renography as a complementary tool in managing pediatric hydronephrosis.

Source: sciencedirect.com/science/article/abs/pii/S1477513124001827