BrifishJournnlof Urology (1991), 67,125-128 01991 British Journal of Urology
Sequential Renography in Acute Urinary Tract Obstruction due to Stone Disease J. P. KELLEHER, R. 0. PLAIL, S. M. DAVE, D. A. CUNNINGHAM, M. E. S N E L L and R. O'N.
WITHEROW Departments of Urology and Clinical Physics, St MaryS Hospital, London
Summary-A group of 76 patients with urographically proven acute calculus obstruction was studied prospectively using 99mT~-DTPA renography to see if kidneys at risk of irreversible renal damage could be identified. There was a statistically significant relationship between the presence of obstruction on renography and the subsequent requirement for intervention, but not with the degree of obstruction (partial or sevlere). Stones over 5 mm in size are highly likely to cause obstruction, a drop in relative renal function and require intervention. In all, 14 patients sustained a drop in relative renal function of > 7% on renography and 12 of these returned to normal limits when their calculi had been passed o r removed. The 2 kidneys whose function remained impaired had fallen below 25% of overall renail function and both patients had received prior treatment for their calculi. No patient who presented de novo suffered any permanent loss of ipsilateral renal function. The results confirm that the criteria for intervention were well founded and emphasise the importance of achieving a stone-free state after primary treatment. Renography is recommended for stones over 5 mm in size, those in the middle and upper ureter and for those patients discharged with a stone in situ. This study was performed to deterinine whether there is an incidence of irreversible renal injury associated with acute upper tract obstruction due to stone disease and its management using traditional clinical criteria. The conventional management of patients with ureteric colic secondary to a ureteric stone is confirmation of the diagnosis by mleans of intravenous urography, followed by admission for observation and pain relief. Subsequent treatment is then justifiably conservative in the first instance because over 50% of stones are small (
Sequential Renography in Acute Urinary Tract Obstruction due to Stone Disease J. P. KELLEHER, R. 0. PLAIL, S. M. DAVE, D. A. CUNNINGHAM, M. E. S N E L L and R. O'N.
WITHEROW Departments of Urology and Clinical Physics, St MaryS Hospital, London
Summary-A group of 76 patients with urographically proven acute calculus obstruction was studied prospectively using 99mT~-DTPA renography to see if kidneys at risk of irreversible renal damage could be identified. There was a statistically significant relationship between the presence of obstruction on renography and the subsequent requirement for intervention, but not with the degree of obstruction (partial or sevlere). Stones over 5 mm in size are highly likely to cause obstruction, a drop in relative renal function and require intervention. In all, 14 patients sustained a drop in relative renal function of > 7% on renography and 12 of these returned to normal limits when their calculi had been passed o r removed. The 2 kidneys whose function remained impaired had fallen below 25% of overall renail function and both patients had received prior treatment for their calculi. No patient who presented de novo suffered any permanent loss of ipsilateral renal function. The results confirm that the criteria for intervention were well founded and emphasise the importance of achieving a stone-free state after primary treatment. Renography is recommended for stones over 5 mm in size, those in the middle and upper ureter and for those patients discharged with a stone in situ. This study was performed to deterinine whether there is an incidence of irreversible renal injury associated with acute upper tract obstruction due to stone disease and its management using traditional clinical criteria. The conventional management of patients with ureteric colic secondary to a ureteric stone is confirmation of the diagnosis by mleans of intravenous urography, followed by admission for observation and pain relief. Subsequent treatment is then justifiably conservative in the first instance because over 50% of stones are small (
