Evaluation of Hydronephrosis in Pregnancy using Ultrasound and Renography

Abstract

The value of ultrasound and 131-Hippuran renography for diagnosing hydronephrosis during pregnancy was investigated. In a control series of 31 symptom-free pregnant women the ultrasonographically measured renal pelvic diameters in the three trimesters were 5, 10 and 12 mm on the right side and 3, 4 and 5 on the left, respectively. In ten healthy non-pregnant women the pelvic diameter varied from 3 to 9 mm on the right side and from 2 to 6 mm on the left side when measured during antidiuresis and water diuresis. Out of 35 pregnant women complaining of flank pain, 31 showed an increased renal pelvic diameter. These 35 women also underwent renography on the same day as the ultrasound examination. In 6 of 27 pregnant women with right-sided pain and in 3 of 8 with left-sided pain, diuresis renography indicated acute ureteral obstruction and in 6 of these 9 patients impairment of renal parenchymal function was also evident. In some cases the impaired renal function was fully reversed after surgical intervention. It is concluded that ultrasound investigation of the kidney is a valuable method for screening prior to renography. Since the negative prediction value of using 17 mm as the upper limit of the pelvic diameter was 100%, patients with a smaller pelvic diameter may not need to be referred further for renography or urography, and radiation will thus be minimized. On the other hand, renography is indicated when the pelvic diameter is more than 17 mm in patients complaining of flank pain.(ABSTRACT TRUNCATED AT 250 WORDS)

Management of Urinary Calculi in Pregnancy: A Review

“…44 In a study that compared the value of US and renography in pregnant women with hydronephrosis, a renal pelvic diameter of less than 17 mm in asymptomatic patients effectively excluded the diagnosis of ureteral calculi. 45 The presence of ureteral jets on real-time US or Doppler US can exclude complete ureteral obstruction in 80.4% to 100% of cases but requires a skilled sonographer. [46][47][48] Intravenous urography (IVU) Lee and Stothers 18 reported that an IVU demonstrated calculi in 16 of 17 patients using a limited protocol.…”

The Comparison of Double J Stent Insertion and Conservative Treatment Alone in Severe Pure Gestational Hydronephrosis: A Case Controlled Clinical Study

“…Although we used the predefined calyceal diameter values [4] to classify the severity of the gestational hydronephrosis, there is a wide variability [8–11] of hydronephrosis definition which causes the reported occurrence varying between 43% and 100% [12]. In the study conducted by Faundes et al a normal curve of dilatation of the urinary tract was proposed and the upper limits of maternal calyceal diameters were defined over 15 mm at some gestational weeks.…”

Pyelocaliectasis and Intrarenal Artery Doppler Indices in Uncomplicated Pregnancies

“…Pelvicaliectasis is more frequent on the right side which the results of our study also supported. Minimal anatomical differences also account for the mechanical obstruction theory [1][2][3][4][5]. The difference of impedance against the flow may be affected from the position and technical differences in the scanning plan.…”

“…In pregnancy, due to altering hemodynamics and physiological factors, the renal collecting system is frequently dilated [1][2][3][4][5]. Contemporary Doppler ultrasonography plays a definitive role in the diagnosis of obstructive and nonobstructive dilatation in the renal collecting system.…”