The aim of this study was to assess the role of MRI as a single modality for anatomical and functional evaluation of obstructed kidneys in patients with compromised renal function. The study included 96 adults with unilateral or bilateral chronic obstructive
hydronephrosis and compromised renal function (serum
creatinine >or=1.8 mg dl(-1)). Patients were subjected to
gadolinium-enhanced MRI (Gd-MRI), which determined the anatomy of both renoureteral units, as well as their function, through selective calculation of the glomerular filtration rate (GFR) of each kidney. All patients underwent a technetium-99m
diethylenetriamine-pentaacetic acid renal scan. Moreover, a correlation was made between the GFR determined by Gd-MRI and the
isotope GFR. The study comprised 59 males and 37 females. A comprehensive MRI study detected the cause of obstruction in all kidneys with non-calcular obstruction (sensitivity of 100%) and in 21 kidneys with calcular obstruction (sensitivity of 70%). The overall sensitivity of MRI combined with plain X-ray of the abdomen and ultrasound in the detection of various causes of obstruction was 97%. A comparison between the
isotope GFR of the obstructed kidneys and the corresponding magnetic resonance urography (MRU) GFR showed perfect correlation. In conclusion, combined static and dynamic MRU is a promising technique that allows anatomical and functional evaluation of obstructed kidneys in patients with impaired renal function but, owing to the possible risk of
nephrogenic systemic fibrosis in patients with a GFR <30 ml min(-1), the lowest possible dose of the most stable Gd-macrocyclic chelates should be used if a functional MRI study is required.