Sonographic Evaluation of Hydronephrosis in the Pediatric Population

Walker, Macie B.; Babikian, Sarkis; Ernest, Alexander; Koch, Troy S.; Lustik, Michael B.; Rooks, Veronica J.; McMann, Leah P.

doi:10.7863/ultra.34.4.655

Cited by 9 publications

(6 citation statements)

References 15 publications

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“…It has been postulated that semi-automated quantitative analysis of US images in HN kidneys may have a potential clinical utility, reducing up to 62% of DRS ( Cerrolaza et al, 2016 ). Other studies have shown good correlation between sonographic findings such as grade of hydronephrosis and ureteral jets pattern and DRF, suggesting a possible role for such parameters in the long-term monitoring of these patients ( De Bessa Jr et al, 2008 ; Erickson et al, 2007 ; Shapiro et al, 2008 ; Tekgul et al, 2012 ; Walker et al, 2015 ).…”

Section: Introductionmentioning

confidence: 78%

Diagnostic accuracy of Onen’s Alternative Grading System combined with Doppler evaluation of ureteral jets as an alternative in the diagnosis of obstructive hydronephrosis in children

Bessa

Rodrigues

Chammas

et al. 2018

PeerJ

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IntroductionUreteropelvic junction obstruction (UPJO) is a common congenital anomaly leading to varying degrees of hydronephrosis (HN), ranging from no apparent effect on the renal function to atrophy. Evaluation of these children is based on Diuretic Renal Scintigraphy (DRS) and Ultrasonography (US). Recent studies have suggested that new parameters of conventional and color Doppler ultrasonography (CDUS) may be useful in discriminating which kidneys are obstructed. The present study aims to assess the diagnostic accuracy of such parameters in the diagnosis of obstruction in children with UPJO.MethodsWe evaluated 44 patients (33 boys) with a mean age of 6.53 ± 4.39 years diagnosed with unilateral high-grade hydronephrosis (SFU grades 3 and 4). All underwent DRS and index tests (conventional US and CDUS to evaluate ureteral jets frequency) within a maximum interval of two weeks. Hydronephrotic units were reclassified according to the alternative grading system (AGS) proposed by Onen et al. Obstruction in the DRS was defined as a differential renal function <40% on the affected side and/or features indicating poor drainage function like T1/2 >20 minutes after the administration of furosemide, and a plateau or ascending pattern of the excretion curve.ResultsNineteen hydronephrotic units (43.1%) were obstructed. Some degree of cortical atrophy—grades 3 (segmental) or 4 (diffuse)—was present in those obstructed units. AGS grades had 100% sensitivity, 76% of specificity and 86.4% of accuracy. The absence of ureteral jets had a sensitivity of 73.68%, a specificity of 100% with an accuracy of 88.6%. When we analyzed the two aspects together and considered obstructed the renal units classified as AGS grade 3 or 4 with no jets, sensitivity increased to 78.9%, accuracy to 92%, remaining with a maximum specificity of 100%. These features combined would allow us to avoid performing DRS in 61% of our patients, leaving more invasive tests to inconclusive cases.ConclusionsAlthough DRS remains the mainstay to distinguishing obstructive from non-obstructive kidneys, grade of hydronephrosis and frequency of ureteral jets, independently or in combination may be a reliable alternative in the mostly cases.This alternative approach has high accuracy, it is less invasive, easily reproducible and may play a role in the diagnosis of obstruction in pediatric population.

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Section: Introductionmentioning

confidence: 78%

Diagnostic accuracy of Onen’s Alternative Grading System combined with Doppler evaluation of ureteral jets as an alternative in the diagnosis of obstructive hydronephrosis in children

Bessa

Rodrigues

Chammas

et al. 2018

PeerJ

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“…APD and PT were the most commonly used sonographic variables to assess the severity of hydronephrosis [19, 20]. Preoperative APD and PT were considered to predict the improvement of renal function after pyeloplasty in Helmy’s study [21].…”

Section: Discussionmentioning

confidence: 99%

Outcome of Renal Function after Laparoscopic Pyeloplasty in Children with High-Grade Hydronephrosis

Zhang

Feng

et al. 2023

Urol Int

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Introduction: This study aimed to analyze the changes in differential renal function (DRF) after laparoscopic pyeloplasty in children with high-grade hydronephrosis and factors influencing DRF improvement. Methods: We reviewed the clinical data of unilateral ureteropelvic junction obstruction (UPJO) patients with SFU grade IV who underwent laparoscopic pyeloplasty between February 2018 and October 2020. The patients were divided into two groups: DRF improvement ≥5% (group 1) and DRF improvement <5% (group 2). Preoperative, operative, and postoperative parameters were included in the statistical analysis in both groups. Results: A total of 29 patients with a median age of 6 months were included. The preoperative DRF in group 1 was significantly lower than that in group 2 (36.97 ± 8.47% vs. 45.19 ± 5.22%, p = 0.004). Logistic regression and receiver operating characteristic analysis showed the preoperative DRF was the predictor for renal function improvement after pyeloplasty (p = 0.021) and had a significant predictive value (p = 0.004). Conclusion: Nearly half of the patients with high-grade UPJO had improved renal function at 1 year follow-up after laparoscopic pyeloplasty. Preoperative DRF was a predictor of renal function improvement, and postoperative functional recovery was superior in children with lower preoperative DRF.

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“…As an accessible, inexpensive, and initial method, ultrasonography was used in both study groups, with indications varying according to the time of diagnosis. Compared to other series, ultrasonography continues to be the most useful diagnostic method and the one with the most significant impact on timely detection at prenatal age, thus providing a more timely intervention that impacts the morphological recovery of the renal unit 8,10,15,16 . The hydronephrosis severity scale applied was the same reported in other case series, which delimits the ideal candidate for surgical management from the morphological point of view, regardless of age and time of diagnosis 6 .…”

Section: Discussionmentioning

confidence: 99%

“…Postnatal pathology was detected in only 12% of children with isolated urinary tract dilation during the second trimester of pregnancy; however, it was present in 40% of those with dilation observed during the second and third trimesters of pregnancy 9 . In general, earlier and more frequent postnatal evaluation is recommended in patients with moderate and severe hydronephrosis (SFU grade III and IV) than those with mild dilatation (SFU grade I and II), as moderate and severe cases are associated with an estimated 5-50% risk of requiring surgical intervention 10 . In children with mild hydronephrosis, a functional study by nuclear renography is not imperative to perform.…”

Section: Introductionmentioning

confidence: 99%

Outcome of the treatment of hydronephrosis due to congenital ureteropelvic stenosis according to age at surgery

Zaragoza-Torres¹,

Cruz-Méndez²,

Baltazar-González³

et al. 2021

BMHIM

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Background: Congenital kidney and urinary tract anomalies are the most common cause of chronic kidney disease in the first three decades of life. Stenosis of the ureteropelvic junction may cause dilation of the collecting system in the fetal kidney. This study aimed to determine hydronephrosis due to congenital ureteropelvic stenosis treatment outcome according to the age of the intervention. Methods: We conducted a retrospective descriptive study that included pediatric patients with hydronephrosis secondary to ureteropelvic junction stenosis operated by the Anderson-Hynes open pyeloplasty method from 2010 to 2016. Patients were divided into two groups: group A, children < 1 year of age, and group B, children > 1 year of age. We analyzed ultrasonographic parameters, renal function, and clinical data. Inferential statistics were used with the Mann-Whitney U-test and X 2 test. Intra-group data were assessed with the Wilcoxon test. Results: We included 52 patients: group A (n = 16, 30%) and group B (n = 36, 70%). The male sex predominated, and mainly the left renal unit. The most important surgical finding was stenotic segment. The median right glomerular filtration rate was 24.1 mL/min (19.0-34.5) pre-surgical and 38.2 mL/min (35.9-41.09) post-surgical in group A (p = 0.028), and 28.4 mL/min (18.5-35.0) pre-surgical and 37 mL/ min (35.7-46.0) post-surgical in group B (p = 0.003). The median left glomerular filtration rate was 30 mL/min (21.4-39.0) pre-surgical and 40.0 mL/min (37.7-44.6) post-surgical in group A (p = 0.005) and 18.4 mL/min (14.2-29.2) pre-surgical and 37 mL/min (33.1-38.5) post-surgical in group B (p < 0.001). Conclusions: Correction of ureteropelvic stenosis before one year of age results in better renal function than a later correction.

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Sonographic Evaluation of Hydronephrosis in the Pediatric Population

Abstract: Hydration does have a substantial effect on the anteroposterior diameter, but it does not correlate with a substantial effect on the SFU grade; therefore, well-tempered sonography seems unnecessary.

Cited by 9 publications

References 15 publications

Diagnostic accuracy of Onen’s Alternative Grading System combined with Doppler evaluation of ureteral jets as an alternative in the diagnosis of obstructive hydronephrosis in children

Diagnostic accuracy of Onen’s Alternative Grading System combined with Doppler evaluation of ureteral jets as an alternative in the diagnosis of obstructive hydronephrosis in children

Outcome of Renal Function after Laparoscopic Pyeloplasty in Children with High-Grade Hydronephrosis

Outcome of the treatment of hydronephrosis due to congenital ureteropelvic stenosis according to age at surgery

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