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Analysis of insulin action using differentiated and dedifferentiated hepatoma cells.

Hepatoma cells in culture exhibit a range of differentiated functions. Well differentiated hepatoma cells retain most of the functions of the adult liver, whereas dedifferentiated cells have lost most of them. In the present study, insulin binding and insulin effects were studied in four differentiated and two dedifferentiated cell lines derived from the Reuber hepatoma and in a partially differentiated cell line, HTC, derived from the Morris 7288C hepatoma. Specific insulin binding was lower in dedifferentiated cells than in partially differentiated and differentiated ones. In all cell lines, analysis of insulin binding yielded linear Scatchard plots. Although some variations in affinity of insulin for its receptor were observed, most of the differences in binding were accounted for by differences in insulin receptor number. In differentiated hepatoma cells, tyrosine aminotransferase (TAT)-specific activity was easily detectable, and insulin produced a 2- to 3-fold increase in enzyme activity within 4-6 h. By contrast, TAT activity in the dedifferentiated cells was low and did not respond to insulin. In the partially differentiated hepatoma HTC, insulin stimulated TAT only after basal TAT activity was induced by glucocorticoid treatment. Glycogen synthase (I and D forms) activities were detectable in all cell lines. In both differentiated and dedifferentiated Reuber hepatoma cells, insulin increased the I-form of glycogen synthase within 15 min. This effect of insulin was observed at lower insulin concentrations than stimulation of TAT activity. By contrast, insulin at any concentration was totally ineffective in stimulating glycogen synthase in glucocorticoid-treated and untreated HTC cells. These results indicate that in hepatoma cells, 1) insulin receptor number and insulin effect on TAT are modulated by the degree of cell differentiation; 2) the pathways of insulin action on TAT and glycogen synthase diverge in some postreceptor step(s) which is under independent control in differentiation; and 3) receptor and postreceptor defects exist in hepatoma cell lines which may be useful in dissecting the pathways of insulin action.

Animals↗

Effect of percutaneous nephrolithotomy on differential renal function as measured by mercaptoacetyl triglycine nuclear renography.

OBJECTIVES: To determine the impact on differential renal function of percutaneous nephrolithotomy for complex renal calculi. METHODS: From July 1999 to December 2000, 45 patients underwent percutaneous nephrolithotomy. Of these, 19 agreed to participate in the study. All patients completed a quantitative assessment of differential renal function preoperatively and postoperatively with technetium 99m mercaptoacetyl triglycine nuclear renography and serum creatinine measurements. RESULTS: The mean patient age was 49 years (range 11 to 75) for the 13 female and 6 male patients. The mean stone burden was 1432 mm(2) (range 156 to 5220). The mean surgical time was 2.57 hours (range 1.17 to 5.08). The median hospital stay was 2.0 days (range 1 to 19). Of the 19 patients, 13 (68%) were stone free after one procedure. Four patients underwent ureteroscopy with stone extraction for residual fragments. One patient underwent secondary extracorporeal shock wave lithotripsy. One patient underwent nephrectomy for poor renal function. Renal function, for the entire group, increased from 36.8% preoperatively to 38.5% postoperatively. Renal function was preserved in 16 (84%) of 19 patients, including improvement of function in 7 (37%) of 19 patients. Serum creatinine was unchanged in the two groups. CONCLUSIONS: Percutaneous nephrolithotomy does not result in loss of renal function when treating complex renal calculi as measured by nuclear scintigraphy. Operative and hospitalization times were decreased compared with historical open nephrolithotomy and stone clearance was similar.

Adolescent↗

Fetal pelvi-ureteric junction obstruction: predictors of outcome.

OBJECTIVE: To examine the relationship between pre-natal ultrasonographic findings typical of pelvi-ureteric junction (PUJ) obstruction and post-natal renal function in the affected kidney. PATIENTS AND METHODS: This retrospective study comprised 35 infants in whom pre-natal ultrasonography had identified a unilateral pattern of dilatation of the renal pelvis and calices typical of PUJ obstruction. In each case, the presence of unilateral hydronephrosis had been confirmed post-natally by ultrasonography, and differential function and drainage evaluated by isotope renography. The results of isotope renography were compared with the severity and timing of onset of the fetal hydronephrosis. RESULTS: Eleven kidneys (31%) appeared normal in the second trimester and dilatation only became apparent during the third trimester. Mean differential function in these kidneys was 48%. However, mean differential function was reduced (mean 38%) in those kidneys noted to be dilated between 16 and 24 weeks gestation. Differential function was loosely correlated with the severity of dilatation in early onset cases, i.e. the mean differential function was 42% for mild, 37% for moderate and 27% for severe dilatation. A considerable variation in differential function values was present in each group except for those with severe dilatation, which was a significant predictor of poor functional outcome when compared with mild and moderate dilatation combined (P < 0.01). CONCLUSION: Fetal PUJ obstruction is a heterogeneous condition permitting only broad predictions of functional outcome. Severe dilatation detected on second trimester imaging predicted significant loss of function. Mild and moderate degrees of dilatation were associated with a one in three risk of functional impairment in the obstructed kidney.

Dilatation, Pathologic↗

The differentiation and function of myofibroblasts is regulated by mast cell mediators.

Myofibroblasts are fibroblasts that express certain features of smooth muscle differentiation. Increased numbers of myofibroblasts and mast cells are frequently found together in a wide variety of settings, such as normal wound repair and scleroderma skin, which suggests that mediators produced by the mast cells could play a role in the regulation of myofibroblast differentiation and function. We used a human mast cell line, HMC-1, to determine if mast cells can induce normal human dermal fibroblasts to differentiate into functional myofibroblasts in vitro. We monitored the differentiation process by assaying two properties of the myofibroblast phenotype: expression of alpha-smooth muscle actin and functional capacity to contract a collagen matrix. In both a simple coculture system and in a skin-equivalent culture system, HMC-1 cells induced alpha-smooth muscle actin expression by fibroblasts. HMC-1 cells also stimulated fibroblast contraction of collagen gels, and the relative amount of contraction was dependent upon the number of HMC-1 cells present. To characterize the individual contributions made by specific mast cell products, we examined the effects of histamine, tumor necrosis factor alpha, and tryptase. Histamine induced a clear increase in alpha-smooth muscle actin expression, but it did not appear to stimulate fibroblast contraction. Tumor necrosis factor alpha had no effect in either assay. Purified human tryptase induced alpha-smooth muscle actin expression, and blocking the proteolytic activity of tryptase with specific inhibitors reduced that response. Tryptase inhibitors also eliminated the ability of HMC-1 cells to stimulate fibroblast contraction, suggesting that tryptase secreted by the HMC-1 cells may be one of the active mast cell mediators.

Actins↗

Visual determination of differential renal function.

Forty patients (43 studies) referred for determination of differential renal function were imaged 24 hours after intravenous administration of Tc-99m-2, 3 DMSA. Visual assessment of relative renal uptake was estimated independently by three observers at three different hospitals from analog images on standard x-ray film. The results were compared with the relative DMSA uptake obtained by summing counts in computer-assisted regions of interest placed over each kidney. There was excellent correlation between the visual estimates of each observer and the computer-generated values (r = 0.98, 0.96, and 0.98, respectively). If a computer is not available, good visual estimates of differential uptake still may be obtained when static imaging agents such as DMSA are administered.

Adult↗

A simple processing method allowing comparison of renal enhancing volumes derived from standard portal venous phase contrast-enhanced multidetector CT images to derive a CT estimate of differential renal function with equivalent results to nuclear medicine quantification.

As iodinated contrast medium is cleared by glomerular filtration, it should be possible to apply the same principles utilized in radionuclide studies to derive differential renal function by comparison of enhancing renal volumes derived from contrast enhanced multidetector CT (CEMDCT). Having established a technique iteratively which appeared successful, a retrospective study was performed using 25 consecutive patients with a wide range of urological conditions who had undergone both CEMDCT, including the renal area in the portal venous phase, and nuclear medicine (NM) assessment of renal function with no urological intervention between the studies. Proprietary volume software was used to quantify the volume and attenuation of each kidney, the products of which (after subtraction of soft tissue attenuation derived from a region of interest over psoas) gave right and left enhancing renal volumes. The contribution by each kidney as a percentage of total renal enhancing tissue was derived. Comparison with NM studies resulted in excellent correlation of relative renal function by CEMDCT and NM assessments having a regression of near unity and a Pearson's correlation coefficient of 0.96. Bland Altman and Passing Bablock tests confirmed good agreement between the two methods with no bias. This is a simple, practicable processing technique using standard portal venous phase CEMDCT images to quantify differential function. This technique may allow a one-stop CT assessment of both anatomy and function.

Adult↗

Differentiation and functions of osteoclasts and odontoclasts in mineralized tissue resorption.

The differentiation and functions of osteoclasts (OC) are regulated by osteoblast-derived factors such as receptor activator of NFKB ligand (RANKL) that stimulates OC formation, and a novel secreted member of the TNF receptor superfamily, osteoprotegerin (OPG), that negatively regulates osteoclastogenesis. In examination of the preosteoclast (pOC) culture, pOCs formed without any additives expressed tartrate-resistant acid phosphatase (TRAP), but showed little resorptive activity. pOC treated with RANKL became TRAP-positive OC, which expressed intense vacuolar-type H(+)-ATPase and exhibited prominent resorptive activity. Such effects of RANKL on pOC were completely inhibited by addition of OPG. OPG inhibited ruffled border formation in mature OC and reduced their resorptive activity, and also induced apoptosis of some OC. Although OPG administration significantly reduced trabecular bone loss in the femurs of ovariectomized (OVX) mice, the number of TRAP-positive OC in OPG-administered OVX mice was not significantly decreased. Rather, OPG administration caused the disappearance of ruffled borders and decreased H(+)-ATPase expression in most OC. OPG deficiency causes severe osteoporosis. We also examined RANKL localization and OC induction in periodontal ligament (PDL) during experimental movement of incisors in OPG-deficient mice. Compared to wild-type OPG (+/+) littermates, after force application, TRAP-positive OC were markedly increased in the PDL and alveolar bone was severely destroyed in OPG-deficient mice. In both wild-type and OPG-deficient mice, RANKL expression in osteoblasts and fibroblasts became stronger by force application. These in vitro and in vivo studies suggest that RANKL and OPG are important regulators of not only the terminal differentiation of OC but also their resorptive function. To determine resorptive functions of OC, we further examined the effects of specific inhibitors of H(+)-ATPase, bafilomycin A1, and lysosomal cysteine proteinases (cathepsins), E-64, on the ultrastructure, expression of these enzymes and resorptive functions of cultured OC. In bafilomycin A1-treated cultures, OC lacked ruffled borders, and H(+)-ATPase expression and resorptive activity were significantly diminished. E-64 treatment did not affect the ultrastructure and the expression of enzyme molecules in OC, but significantly reduced resorption lacuna formation, by inhibition of cathepsin activity. Lastly, we examined the expression of H(+)-ATPase, cathepsin K, and matrix metalloproteinase-9 in odontoclasts (OdC) during physiological root resorption in human deciduous teeth, and found that there were no differences in the expression of these molecules between OC and OdC. RANKL was also detected in stromal cells located on resorbing dentine surfaces. This suggests that there is a common mechanism in cellular resorption of mineralized tissues such as bone and teeth.

Acid Phosphatase↗

Procedures for the analysis of differential item functioning (DIF) for small sample sizes.

An item with differential item functioning (DIF) displays different statistical properties, conditional on a matching variable. The presence of DIF in measures can invalidate the conclusions of medical outcome studies. Numerous approaches have been developed to examine DIF in many areas, including education and health-related quality of life. There is little consensus in the research community regarding selection of one best method, and most methods require large sample sizes. This article describes some approaches to examine DIF with small samples (e.g., less than 200).

Health Status Indicators↗

A differentiable, periodic function for pulsatile cardiac output based on heart rate and stroke volume.

Many mathematical models of human hemodynamics, particularly those which describe pressure and flow pulses throughout the circulatory system, require as specified input a modeling function which describes cardiac output in terms of volume per unit time. To be realistic, this cardiac output function should capture, to the greatest extent possible, all relevant features observed in measured physical data. For model analysis purposes, it is also highly desirable to have a model function that is continuous, differentiable, and periodic. This paper addresses both classes of needs by developing such a function. Physically, the present function provides an accurate model for flow into the ascending aorta. It is completely specified by a minimal number of standard input parameters associated with left ventricle dynamics, including heart rate, mean cardiac output, and an estimation of the peak-to-mean flow ratio. Analytically, it can be expressed as a product of two continuous, differentiable and periodic factors. Further, the Fourier expansion of this model function is shown to be a finite Fourier series, and explicit closed-form expressions are given for the non-zero coefficients in this series.

Animals↗

Evaluation of differential renal function studies in segmental renal artery occlusion.

3 patients with suspected renal segmental ischaemia are presented. In 2 of them segmental renal artery stenosis was demonstrated radiographically and the differential renal function studies predicted the outcome of surgery accurately. In the last patient no segmental renal artery stenosis was demonstrated on angiography, and surgery did not benefit this patient in spite of positive differential renal function studies for "curable" renal segmental ischaemia. Some haemodynamic aspects, as expressed by the differential renal function studies, are discussed.

Adult↗

Evaluation of functional heterogeneity in the CD8 subset with T cells from T cell receptor-transgenic mice.

The question of functional differentiation within the CD8 subset has been addressed in a model of TcR-transgenic (TcR-tg) mice expressing a TcR specific for H-2Kb (Ti). CD8+ Ti+ T cells present in the periphery of these mice have no cytotoxic T lymphocyte (CTL) activity unless they are stimulated with H-2Kb-expressing cells. In contrast to T cells from normal H-2k littermates, alloantigen induction of CTL from TcR-tg mice is independent of CD4+ T helper (Th) cells and is accompanied by high level secretion of interleukin-(IL)-2 by Ti+ CD8+ T cells. Precursor frequency analysis performed on CD8+ cells from TcR-tg mice revealed a high frequency of Th as compared to CTL precursors. This raised the possibility of the existence of distinct subpopulations within CD8+ precursors with different requirements for differentiation to functional CTL. FACS analyses (performed on resting and on in vitro stimulated T cells from normal and TcR-tg mice) demonstrated a heterogeneous expression of Ly-6C on CD8+ cells with a large enrichment of Ly-6C- cells among the Ti+ cells which persisted after stimulation with H-2b cells in conditions that led to a homogeneous expression of the activation markers pgp-1 and CD69. The possibility that Ly-6C expression could mark functionally different subpopulations in CD8+ T cells was investigated. Stimulation of sorted populations of Ly-6C- and Ly-6C+ cells allowed detection of CTL precursors in both these subsets and the majority of limiting dilution wells containing one pCTL also scored positive for IL-2 secretion. Thus, for CD8+ T cells expressing the same TcR, differentiation led to acquisition of both IL-2 secretion and CTL function and there was no evidence for the existence of a distinct population of helper-dependent CTL precursors.

Animals↗

Phorbol ester and phospholipase C-mediated differentiated thyroid function in vitro: the effects of protein kinase C inhibition and downregulation.

Tumor-promoting phorbol esters, e.g., 12-O-tetradecanoylphorbol 13-acetate (TPA), inhibit TSH-stimulated iodide organification in vitro implying a role for protein kinase C (PKC) in the regulation of differentiated thyroid function. To further explore the PKC dependence of this action of TPA, we studied the effects of PKC inhibition and downregulation on phorbol-mediated differentiated thyroid function in vitro. In addition, the effects of the nonphorbol PKC activator, phospholipase C (PLC) were studied. TPA (100 nM) inhibited TSH-stimulated iodide organification in cultured porcine thyroid cells by over 95% and caused PKC translocation in vitro. Exogenous PLC (1 U/mL) could mimic these effects of TPA. The PKC inhibitor, 1-(5-isoquinolinesulfonyl)-2-methylpiperazine (H7) inhibited TSH-stimulated iodide organification at concentrations exceeding 10 microM. However, partial recovery of phorbol- and PLC-inhibited iodide organification was seen in the presence of identical concentrations of H7. H7 had no effect on PKC translocation in porcine thyroid cell extracts. After 24 h of TPA treatment to induce PKC downregulation, no recovery of TSH-stimulated iodide organification was observed, suggesting that the effects of TPA were irreversible. These studies indicate that the effects of TPA and PLC on differentiated thyroid function are mediated, at least in part, by PKC. These findings provide further evidence for a role for PKC in the regulation of differentiated thyroid function.

1-(5-Isoquinolinesulfonyl)-2-Methylpiperazine↗

Pathobiological behavior and molecular mechanism of signet ring cell carcinoma and mucinous adenocarcinoma of the stomach: a comparative study.

AIM: To elucidate the distinctive pathobiological behavior between signet ring cell carcinoma (SRC) and mucinous adenocarcinoma of the stomach. METHODS: Based on the histological growth patterns and cell-functional differentiation classifications of stomach carcinoma, we conducted a series of comparative studies. All paraffin-embedded and frozen blocks were collected from the files of Cancer Institute of China Medical University. On the basis of histopathological observation, we applied enzymatic and mucous histochemistry, immunohistochemistry, flow cytometry (FCM) and molecular biology to compare these two categories of gastric cancers in terms of the DNA ploidy, proliferative kinetics, the expression of gastric carcinoma associated gene product and instabilities of mitochondrial DNA (mtDNA). RESULTS: Gastric SRC was commonly seen in females below 45 years, mostly presenting diffuse growth and ovary or uterine cervix metastasis. The majority of SRC were absorptive and mucus-producing functional differentiation type (AMPFDT), which growth relied on estrogen. Meanwhile, stomach mucinous adenocarcinomas were mostly observed in males over 50 years, prone to massive growth or nest growth and extensive peritoneal infiltration, showing two categories of cell-functional differentiation types: AMPFDT and mucus-secreting functional differentiation type (MSFDT). Expressions of ER, enzyme c-PDE and 67kDaLN-R in SRC were evidently higher than that in mucinous adenocarcinoma, while expressions of LN, CN-IV, CD44v6, and PTEN protein were obviously lower in SRC than that in mucinous adenocarcinoma (P<0.05). There was no statistic significance in VEGF, ECD and instabilities of mtDNA (P>0.05) between the above two gastric carcinomas. CONCLUSION: Though SRC and mucinous adenocarcinoma were both characterized by abundant mucus-secretion, they were quite different in morphology, ultrastructure, cell-functional differentiation and protein expression, indicating different mechanisms of carcinogenesis. We concluded that combining histological growth patterns, cell-functional differentiation type with tumor related markers might be significant in early diagnosis and prognosis assessment for SRC and mucinous adenocarcinoma of the stomach.

Adenocarcinoma, Mucinous↗

Role of technetium-99m N,N-ethylenedicysteine renal scintigraphy in the evaluation of differential renal function and cortical defects.

PURPOSE: This study was performed to evaluate the effectiveness of technetium-99m N,N-ethylenedicysteine (Tc-99m EC) in comparison to technetium-99m dimercaptosuccinic acid (Tc-99m DMSA) scintigraphy. Differential renal function (DRF) was calculated by both methods and the cortical-phase images of dynamic Tc-99m EC scintigraphy were evaluated for parenchymal defects. MATERIALS AND METHODS: A total of 62 patients with various kidney disorders ranging in age from 1 to 44 years underwent both Tc-99m DMSA and Tc-99m EC scintigraphy. Tc-99m EC summed images of the cortical phase and Tc-99m DMSA images were evaluated visually and quantitatively. Visual analysis was used to define renal parenchymal abnormalities. Quantitative analysis was used in the calculation of DRF. The Tc-99m DMSA scan was taken as the gold standard, and the summed Tc-99m EC scan findings were compared against it. RESULTS: The images obtained with Tc-99m DMSA and Tc-99m EC scintigraphy revealed 99 and 97 focal defects, respectively. The 2 renal parenchyma defects located in the ventral middle sections remained undetected with Tc-99m EC scintigraphy. DRF of the kidneys in each patient was compared using both radiopharmaceuticals. Highly positive correlation between the differential function of these 2 investigations was found (R = 0.91, P = 0.001). The values of mean DRF of the left kidney on Tc-99m EC and Tc-99m DMSA images were 45.8 +/- 19.1 and 45.0 +/- 20.4, respectively. There were no significant differences (P > 0.05). CONCLUSION: This study suggests that although Tc-99m DMSA scintigraphy remains the gold standard method for evaluating parenchymal abnormalities, Tc-99m EC scintigraphy can be a reliable single-modality study to evaluate renal cortical defects, DRF, perfusion, drainage of the urinary system, and indirect evidence of vesicoureteric reflux with the added advantage of low radiation exposure to the patient.

Adolescent↗

Prostaglandin D2 affects the differentiation and functions of human dendritic cells: impact on the T cell response.

The local environment in which dendritic cells (DC) differentiate is important for the acquisition of their immunostimulatory properties. Since prostaglandin D(2) (PGD(2)), a major prostanoid produced during inflammatory reactions, is involved in the control of immune responses, its effect on the differentiation and functions of human monocyte-derived dendritic cells (MDDC) was studied. We show that DC differentiated in the presence of PGD(2) (PG/DC) have an unusual phenotype, with modifications in the expression of molecules involved in antigen (Ag) capture and presentation, leading to higher endocytic and Ag-processing activities. However, under conditions that necessitated Ag processing and presentation, PG/DC have an impaired ability to stimulate naive T cells, whereas superAg-pulsed DC efficiently promote their proliferation. Upon lipopolysaccharide or TNF-alpha/IL-1beta stimulation, PG/DC phenotypically mature but produce abnormal amounts of immunoregulatory cytokines (decreased IL-12p70/IL-10 ratio). Moreover, mature PG/DC fail to up-regulate the chemokine receptor CCR7 and show an impaired migration towards its ligand CCL19. Finally, PG/DC favor the differentiation of naive T cells toward Th2 cells, an effect dependent on IL-10 and inducible costimulator ligand expression by DC. Most of the herein described effects of PGD(2) on MDDC can be reproduced, usually with a higher efficacy, with a selective D prostanoid receptor (DP)1, but not DP2, agonist. Taken as a whole, these results demonstrate that PGD(2) impacts DC differentiation and functions, and extend the concept that it exerts important roles in immunity.

Antigen Presentation↗

5-Hydroxymethyluracil-DNA glycosylase activity may be a differentiated mammalian function.

To determine the prevalence of the repair enzyme HMU-DNA glycosylase we assayed its activity in whole cell extracts of several bacterial species, the eukaryotic yeast Saccharomyces cerevisiae, mammalian cell lines and murine tissue. Enzyme activity was constitutively present in murine, hamster and human cell lines. It was not inducible by exposing cells to oxidative stress from ionizing radiation or by incubating cells with the 2'-deoxynucleoside of HMU, HMdU. In murine tissue, enzyme activity was highest in brain and thymus. HMU-DNA glycosylase activity was not detectable in bacteria or yeast nor could activity be detected after exposure of cells to H2O2. These results suggest that, in contrast to other DNA-repair enzymes, HMU-DNA glycosylase is a differentiated function limited to higher eukaryotic organisms.

Animals↗

[Pharmacological electrocardiographic tests in the differentiation of functional and organic changes in the myocardium in malignant neoplasms].

Differentiation between functional and organic changes in the myocardium is essential for choosing treatment modality and, particularly, premedication. Individually-tailored application of standard pharmacological ECG tests using atropine, inderal and other drugs is still justified. They are more available than some newly-developed methods which are diagnostically superior.

Atropine↗

Supranormal renographic differential renal function in congenital hydronephrosis: fact, not artifact.

PURPOSE: Children with unilateral hydronephrosis, who had been prospectively examined with diethylenetriaminepentaacetic acid (DTPA) and dimercapto-succinic acid (DMSA) renography, were evaluated to determine whether supranormal renographic differential renal function exists. MATERIALS AND METHODS: A total of 54 children with congenital single system hydronephrosis underwent abdominal ultrasound, voiding cystourethrogram, and DTPA and DMSA renal scans. None had abnormalities of the bladder or contralateral kidney. Differential renal function greater than 55% was defined as supranormal. RESULTS: Of the 54 patients 15 (28%) with a median age of 4 months (range 0.5 to 66) were identified with supranormal renographic renal function on either DTPA or DMSA. Supranormal renographic renal function was detected by DMSA in 9 cases (mean 57+/-2%), DTPA in 8 (mean 58+/-2%) and both in 2 (mean 57+/-2%). Average function demonstrated in the 15 patients was 55+/-3% (range 51 to 62) with DMSA which was not different from that found with DTPA (mean 55+/-4%, range 46 to 61%). The kidneys with supranormal renographic renal function were significantly larger than hydronephrotic controls according to longitudinal parenchymal area on DMSA. Mean followup was 20 months for 13 patients, with 8 of 13 (62%) undergoing pyeloplasty. Followup DTPA renal scans available in 9 children revealed persistent supranormal function in 6, despite pyeloplasty in 3. CONCLUSIONS: Supranormal renographic differential renal function does exist in congenital hydronephrosis and when found the kidneys are consistently enlarged. The position of supranormal renographic renal function in the management algorithm of hydronephrosis remains to be elucidated as it does not appear to be a benign prognostic factor.

Child, Preschool↗