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Year : 2022  |  Volume : 38  |  Issue : 4  |  Page : 327
 

Re: Sharma GR, Sharma AG, Sharma NG. Comparison of two drainage parameters on diuretic renogram in predicting the fate of prenatally detected pelvi-ureteric junction-like obstruction. Indian J Urol 2022;38:216-9


1 Department of Urology, Max Super Speciality, AIIMS, New Delhi, India
2 Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India

Date of Submission13-Jul-2022
Date of Acceptance26-Aug-2022
Date of Web Publication1-Oct-2022

Correspondence Address:
Ritesh Goel
Department of Urology, Max Super Speciality, AIIMS, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/iju.iju_245_22

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How to cite this article:
Goel R, Gupta P. Re: Sharma GR, Sharma AG, Sharma NG. Comparison of two drainage parameters on diuretic renogram in predicting the fate of prenatally detected pelvi-ureteric junction-like obstruction. Indian J Urol 2022;38:216-9. Indian J Urol 2022;38:327

How to cite this URL:
Goel R, Gupta P. Re: Sharma GR, Sharma AG, Sharma NG. Comparison of two drainage parameters on diuretic renogram in predicting the fate of prenatally detected pelvi-ureteric junction-like obstruction. Indian J Urol 2022;38:216-9. Indian J Urol [serial online] 2022 [cited 2022 Dec 1];38:327. Available from: https://www.indianjurol.com/text.asp?2022/38/4/327/357731




We have read with great interest, the article by Sharma et al.,[1] comparing the T ½ and normalized residual activity (NORA) in diuretic renograms. This is a promising marker to accurately diagnose ureteropelvic junction obstruction (UPJO). NORA was first described for by Piepsz et al.[2] in 2000, and as per their observation, NORA is an easily reproducible tool that was independent of renal function and time of furosemide injection. It is calculated by measuring residual counts in region of interest, i.e., the renal parenchyma and the dilated pelvicalyceal system for a duration of 1 min at 60 min of dynamic imaging as total percentage of the renal counts in the second min after injection of the radiopharmaceutical agent.[3] This article highlights the nonagreement between NORA and T ½ to diagnose UPJO.

However, while reading and understanding the article, we came across some issues. NORA versus T ½ can only truly be assessed through randomized controlled trials. The objective parameters must be designed as such to avoid any underdiagnosis. Surgery was advised only in six patients out of 34, when DRF reduced below 40% although 19 other patients showed poor T ½ curves. This means that neither NORA nor T ½ was taken into consideration in decision-making. In six patients who were advised surgery, in whom DRF reduced below 40%, only two patients were diagnosed as truly obstructive by NORA (33%) compared to five patients by T ½ method (83.33%). Finally, since the study had average follow-up of 26 months, it would be important to know the follow up of those 19 patients with poor T ½ in whom surgery was not advised. This would further augment the belief that NORA was better tool to accurately detect the patients who did well without surgery.

Financial support and sponsorship: Nil.

Conflicts of interest: There are no conflicts of interest.



 
   References Top

1.
Sharma GR, Sharma AG, Sharma NG. Comparison of two drainage parameters on diuretic renogram in predicting the fate of prenatally detected pelvi-ureteric junction-like obstruction. Indian J Urol 2022;38:216-9.  Back to cited text no. 1
  [Full text]  
2.
Piepsz A, Tondeur M, Ham H. NORA: A simple and reliable parameter for estimating renal output with or without frusemide challenge. Nucl Med Commun 2000;21:317-23.  Back to cited text no. 2
    
3.
Majd M, Bar-Sever Z, Santos AI, De Palma D. The SNMMI and EANM procedural guidelines for diuresis renography in infants and children. J Nucl Med 2018;59:1636-40.  Back to cited text no. 3
    




 

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