PubMed · 5390622
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F Marx, H Günther. 1969. [Dehydration urography].. https://pubmed.ncbi.nlm.nih.gov/5390622/
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Dynamic renal scintigraphy (DRS) during controlled diuresis is the method of choice to diagnose the functional relevance of urinary tract obstruction in children with sonographically demonstrated hydronephrosis. However, there are no commonly accepted scintigraphic criteria for surgical intervention. On the basis of our findings, we propose four stages of washout (WO) of tracer following diuresis: in stage I, WO>50%, neither further diagnosis nor intervention is necessary; in stage II, 50%>/=WO>/=12%, repetition of DRS is advised within 3-4 months; and in stage III, 12%>WO>/=5%, DRS should be repeated within 1-2 months. Only in stage IV, WO<5%, should surgery be done immediately. This procedure reduces surgical interventions by 50% without increasing the risk of residual renal damage.
British contributions to renal physiology trace back to the seminal contribution of William Bowman, who defined the structure of mammalian nephron and its blood supply and pointed out its likely mode of function. A series of contributions followed, which stemmed from a distinguished lineage of physiologists based at University College London and which had, as its high point, the establishment by Ernest H. Starling, in 1899, of a method for measuring oncotic pressure and the subsequent demonstration that glomerular filtration requires a hydrostatic pressure in excess of oncotic pressure in the glomerular capillaries. Arthur Cushny published a monograph on renal function in 1917 which had wide influence. The homeostasis of water and sodium chloride were the subjects of important contributions by Verney and De Wardener, respectively. Little contribution was made by British renal physiologists to the understanding of single nephron function with the emphasis being largely on integrative physiology.
OBJECTIVE: This pilot study evaluates the efficacy of low-dose theophylline administered before furosemide to enhance diuresis in neonates recovering from fluid retention during extracorporeal membrane oxygenation (ECMO). STUDY DESIGN: Infants receiving ECMO (n = 24) were randomized (double blind, placebo-controlled) to receive either regimen A (placebo/furosemide day 1, theophylline/furosemide day 2, placebo/furosemide day 3) or regimen B (theophylline/furosemide day 1, placebo/furosemide day 2, theophylline/furosemide day 3). Urine flows and renal functions were compared. RESULTS: Urine flow rate before initiation of diuretic therapy was not significantly different between groups A and B (2.6 +/- 1.4 vs 3.5 +/- 1.3 ml/kg/hr, respectively, p = 0.12). Infants who received theophylline/furosemide had significantly higher urine flow rates than those who received placebo/furosemide on day 1 (11.8 +/- 4.6 vs 7.2 +/- 2.4 ml/kg/hr, p < 0.01). The 24-hour fluid volumes and balances became significantly more negative with theophylline enhancement of furosemide's effect. There were no significant differences in renal function between the two groups. CONCLUSION: Low doses of theophylline given before furosemide administration significantly enhance diuretic response in infants with fluid retention during ECMO.