Sonographic sign of intermittent dilatation of the renal collecting system in 10 patients with vesicoureteral reflux

Weinberg, Brighita; Yeung, Norman

doi:10.1002/(sici)1097-0096(199802)26:2<65::aid-jcu2>3.3.co;2-k

Cited by 5 publications

(6 citation statements)

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“…Whereas VUR is detected in voiding cystourethrography (VCUG) in a substantial proportion of sonographically normal kidneys, many children with incidentally detected mild renal pelvic distention do not have VUR [5]. On the other hand, the kidneys are usually imaged during routine abdominal ultrasonography performed in normal infants, or in those with diseases unrelated to the urinary tract, and mild renal pelvic distention is often observed as an incidental finding.…”

Section: Introductionsupporting

confidence: 87%

Mild hydronephrosis in newborns and infants: can ultrasound predict the presence of vesicoureteral reflux

et al. 2007

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The objective of our study was to determine the significance of mild hydronephrosis in newborns and infants as an indicator of vesicoureteral reflux (VUR). The voiding cystourethrography (VCUG) of 573 patients aged 0-18 months with mild, sonographically detected hydronephrosis were reviewed for VUR. Patients with secondary reflux or anomalies making an exact reflux grading impossible were excluded. Normal kidneys, contralateral to hydronephrotic ones, were included. Each kidney was considered separately, forming a total of 1,146 renal units. Mild hydronephrosis was defined as an anteroposterior diameter of the renal pelvis of 0.5-1.5 cm without caliectasis. The International Grading System was used to grade VUR. Seven hundred and thirty-six kidneys had mild hydronephrosis. VUR occurred in 189 out of 736 (25.7%) of these kidneys, and in 108 out of 410 (26.3%) non-distended kidneys, contralateral to hydronephrotic ones (p=0.806). No statistical differences in the frequency of VUR and dilatation were found between the subgroups of patients with and without infection, except for a higher grade of reflux in the group with infection. The frequency of VUR in mildly dilated kidneys was not significantly different from that in non-distended ones. There was a poor correlation between VUR and mild hydronephrosis. The latter should not be considered in itself an indication for VCUG in asymptomatic neonates and infants.

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Section: Introductionsupporting

confidence: 87%

Mild hydronephrosis in newborns and infants: can ultrasound predict the presence of vesicoureteral reflux

et al. 2007

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“…This prospective study has confirmed the hypothesis that fluctuation of the renal pelvis is associated with highgrade VUR, as others have suggested [9,10,11]. Highgrade VUR was persistent in those with fluctuation, necessitating surgery in the majority.…”

Section: Discussionmentioning

confidence: 99%

“…These sonographic signs include pelvic or ureteral wall thickening [2,6], calyceal or ureteral dilatation [2], pelvic dilatation [3,7], absence of corticomedullary differentiation [2,3], hyperechoic cortex or renal cysts [2,3], displacement of ureteric jet in the bladder [8], and intermittent dilatation and ballooning of the collecting system [9,10,11].…”

Section: Introductionmentioning

confidence: 99%

Fluctuating fetal or neonatal renal pelvis: marker of high-grade vesicoureteral reflux

Anderson¹,

Allan

Abbott³

2004

Pediatric Nephrology

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Fetal renal pelvic dilatation is a predictor of vesicoureteral reflux (VUR), but has low specificity. The aim of this study was to determine the clinical significance of fluctuating size of the renal pelvis on sonography, particularly in relationship to VUR. We prospectively recorded fetal renal pelvic diameter >/=4 mm in 1,092 fetuses (692 boys), from May 1989 to December 1995, with a minimum follow-up of 7 years. Fluctuation, defined as size of renal pelvis changing by more than 4 mm during the course of obstetric (23), postnatal (128), and both pre- and postnatal (7) renal sonograms, was recorded prospectively in 159 (117 boys). Of the 1,092, 849 (593 boys) had a voiding cystourethrogram at a mean age of 7 weeks (range 3-20 weeks). Of the 31 (16 girls) with high-grade VUR, fluctuation was observed in 20 (9 girls). Fluctuation was strongly associated with high-grade VUR (odds ratio 11.1, P=0.0000003) and with renal damage (sensitivity 61%, positive predictive value 31%). Primary high-grade VUR was persistent, seen equally in boys and girls, and required surgery in the majority. Fluctuation was associated with renal duplication anomalies ( P=0.00009) and megaureter ( P<0.00000001). Fluctuation of the renal pelvis on sonography is a marker for persistent high-grade VUR and renal damage in girls and boys.

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“…Blane et al [14], in an examination of 493 patients who underwent VCUG and US within an 8-h interval of one another, found that 74% of the kidneys with VUR were normal on US, including 28% with grade 3 or higher reflux. Even the sonographic sign of intermittent dilatation of the renal collecting system is mainly seen in high reflux grades [15]. Scanning during voiding, to detect newly appearing or an increase in existing ureteral or pelvicalyceal dilatation, did not add to the sensitivity of US in the diagnosis of VUR [16,17,18].…”

Section: Indirect Us Methodsmentioning

confidence: 99%

Diagnosis of vesicoureteral reflux with ultrasonography

Darge

2002

Pediatric Nephrology

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The primary diagnostic procedure for evaluation of vesicoureteral reflux (VUR) in children is fluoroscopic voiding cystourethrography (VCUG). Radionuclide cystography (RNC) is an alternative, sensitive method for diagnosing VUR, but it lacks spatial resolution. Over the past 2 decades, in an effort to eliminate the radiation exposure intrinsic to these methods, many endeavors had been made to use ultrasonography (US) for the diagnosis of VUR. The various attempts that have been undertaken are reviewed. The real breakthrough in the US diagnostic option has come with the availability of stable US contrast media that can be administered intravesically. Comparison between contrast-enhanced sonographic reflux examination (voiding urosonography, VUS) and VCUG/RNC has revealed the high concordance between these imaging modalities regarding the diagnosis or exclusion of VUR. Imaging of the urethra still necessitates the performance of VCUG. VUS is used in routine imaging primarily for follow-up cases, girls, and screening high-risk groups for reflux. Using these selection criteria, the number of VCUG investigations can be reduced by over half and, consequently, a significant reduction of radiation exposure in children can be achieved. With the emergence of harmonic US imaging, the sonographic reflux examination will gain further diagnostic potential and widespread application. The whole field of sonographic diagnosis of reflux is still in the process of rapid development.

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Sonographic sign of intermittent dilatation of the renal collecting system in 10 patients with vesicoureteral reflux

Cited by 5 publications

References 0 publications

Mild hydronephrosis in newborns and infants: can ultrasound predict the presence of vesicoureteral reflux

Mild hydronephrosis in newborns and infants: can ultrasound predict the presence of vesicoureteral reflux

Fluctuating fetal or neonatal renal pelvis: marker of high-grade vesicoureteral reflux

Diagnosis of vesicoureteral reflux with ultrasonography

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