Dificultades en la interpretaci車n del Renograma Diur谷tico en ni os.

作者：Morales Klinkert; Barbara

来源：Alasbimn Journal, 2005.

• Diuretic Renography
• radiopharmaceuticals
• Tc99mMAG3
• pitfalls
• guidelines
• consensus panels.

El renograma diur谷tico contin迆a siendo el estudio funcional de car芍cter no invasivo de elecci車n en la evaluaci車n de pacientes con hidronefrosis y probable obstrucci車n pielo-ureteral. Para una adecuada interpretaci車n de 谷ste es esencial dar una meticulosa atenci車n a factores como la preparaci車n previa del paciente, la selecci車n del radiof芍rmaco, la dosis y administraci車n del diur谷tico, la interpretaci車n de las im芍genes y el conocimiento de los potenciales errores de la t谷cnica. Para la mayor赤a de los pacientes el protocolo F+20 es suficiente, sin embargo el protocolo F-15 puede ayudar a clarificar los casos equ赤vocos del protocolo F+20. Las t谷cnicas invasivas como el test de Whitaker son reservadas para aquellos pacientes con hidronefrosis severa o con insuficiencia renal en donde el diagn車stico cl赤nico a迆n persiste equ赤voco despu谷s de haber efectuado el renograma. Las recientes publicaciones de gu赤as de protocolos estandarizados y consensos internacionales han contribuido a unificar criterios y as赤 mejorar la agudeza diagn車stica y la reproducibilidad de la t谷cnica.Diuretic renal scintigraphy was developed in the 1970s as a non invasive method to diagnose and follow up patients with hydronephrosis and obstructive uropathy and remains the noninvasive functional study of choice in these patients. Over the years, a wide variety of protocols and techniques have been developed. Unfortunately, this has contributed to increase the variability in the interpretive criteria among the different nuclear medicine departments. For an appropiate interpretation of the diuretic renography and to avoid and minimize the number of indetermined studies it is essential a meticulous attention to details such as hydration of the child, radiopharmaceutical selection, dosage and time of Furosemide administration, bladder status and effect of gravity and an awareness of the potential pitfalls of the technique. For most patients the F+20 protocol is sufficient, however the F-15 protocol allows clarification in some equivocal baseline F+20 studies. Invasive techniques such as the Whitaker test are best reserved for the group in whom the diagnosis remains equivocal after diuretic renography. The new guidelines published and the protocols recommended by the recent international consensus panels have contributed to increase the reproducibility of the technique.