F+0 diuretic protocol is superior to F-15 and F+20 for nuclear renogram in children

INTRODUCTION: We compare the outcomes of three different diuretic protocols for renograms in children with hydronephrosis. MATERIALS AND METHODS: Between August 2011 and July 2013, 148 diuretic renograms were performed to evaluate unilateral grade 3–4 hydronephrosis (reflux, posterior urethral valves, post-pyeloplasty status excluded). Patients were allotted into three groups based on the timing of diuretic administration: Diuretic given 15 min before (F-15), at the same time as (F + 0) and 20 min after (F + 20) radionuclide administration. Dynamic images and renogram curves were inspected to identify in each group (1) number of equivocal curves and (2) number of interrupted studies due to patient movement/discomfort/voiding. Statistical significance was determined by the Fisher exact test. RESULTS: There was no significant difference in age/sex distribution between groups F-15 (n = 35), F + 0 (n = 38) and F + 20 (n = 75). The number of equivocal curves was significantly less in F + 0 (2/38) and F-15 (3/35) compared with F + 20 (20/75). The number of interrupted studies was significantly less in F + 0 (2/38) compared with F-15 (9/35) and F + 20 (18/75). CONCLUSION: The F + 0 and F-15 protocols are superior to the F + 20 protocol in reducing the number of equivocal curves, while the F + 0 protocol is superior to the other two in reducing interruptions due to patient movement or voiding. F + 0 is the diuretic protocol of choice for renogram in children.