A Comparison Between Diuresis Renography and the Whitaker Test in 64 Kidneys

Abstract

Fifty-seven patients have provided 64 dilated pelvicaliceal units for study by diuresis renography and the Whitaker test. Of 45 kidneys showing a type I or type llla renographic response (unobstructed), 3 2 were, according to Whitaker's criteria, obstructed, 8 fell into an equivocal zone and only 5 were unobstructed. Thirty-five of these kidneys-33 of which were associated with moderate or severe loin pain-were operated on for presumed obstruction with generally excellent symptomatic and renographic result. Thus the detection of a type I or type llla response in a dilated, painful system cannot be taken to exclude obstruction. Better correlation was obtained between renography and the Whitaker test in patients exhibiting a type lllb or type II renographic response. Diuresis renography is a sensitive indicator of urodynamic disturbance in the upper urinary tract and an ideal means of evaluating post-operative progress. The Whitaker test provides a reliable means of selecting patients who will benefit from pyeloplasty.

Ureteral stenosis after kidney transplantation.

“…If diagnosis is still dubious, a pressure-perfusion test according to Wittaker through a pyelostomy or a diuretic -nephroscintigraphy has been advised. This last technique was not very helpful in our series as in others' [5,7] and we never did a Wittaker test.…”

Diuresis Renography. Recent Advances and Recommended Protocols

“…Unfortunately, this method results in an equivocal rate of 15% in our hands, and often considerably more in other centres, producing indeterminate washout and an inconclusive result. This, and variable correlation of the test with perfusion pressure flow studies (Hay et al, 1984; Lupton, 1984; Poulsen et al, 1987) stimulated attempts to improve the accuracy of the procedure and minimise the possibility of equivocal responses, measures which have been incorporated into a series of recommended protocols for the performance and interpretation of diuresis renography.…”

Diuretic‐induced Urinary Flow Rates at Varying Clearances and their Relevance to the Performance and Interpretation of Diuresis Renography

“…Even its strongest supporters recognise that it is difficult to interpret sub-total washout when the flow rate in terms of ml/min/kidney is not known. In addition, several recent reports have identified discrepancies between the results of perfusion pressure flow studies, which use a fixed perfusion rate of 10 ml/min, and diuresis renography, which depends on an individual and potentially variable response to frusemide (Hay et al, 1984;Whitaker and Buxton Thomas, 1984;Senac etal., 1984;Gonzales and Chiou, 1985;Kass el al., 1985). For uniform results it can be restated that the patient should be well hydrated, should empty his bladder before the test, should have the examination in the sitting position to reflect the normal influence of hydrostatic pressure on urine transport, and should be given 0.5 mg/kg frusemide intravenously, although in adults over 16 years a standard minimum dose of 40 mg can be used.…”