Abstract
To correlate sonographic renal parenchymal measurements among patients with ureteropelvic junction obstruction (UPJO) labeled society of fetal urology (SFU) hydronephrosis grades 1-4 and to examine whether sonographic renal parenchymal measurements could be used to differentiate conservative vs. surgical management. Retrospective chart review and sonographic renal parenchymal measurements (renal length, medullary pyramid thickness, and renal parenchymal thickness) were performed in patients with SFU grades 1-4 hydronephrosis secondary to UPJO managed between 2009 and 2014. Exclusion criteria included other concomitant genitourinary pathology or incomplete follow-up. Anterior-posterior renal pelvic diameter (APRPD) and radionuclide renography were also evaluated when available. One hundred four patients with UPJO underwent 244 renal and bladder ultrasound (1,464 sonographic renal parenchymal measurements in 488 kidneys). Medullary pyramid thickness and renal parenchymal thickness progressively decreased from SFU grades 1-4 (p < 0.05). A similar trend was appreciated when comparing SFU grades 1 and 2 vs. 3 and 4, as well as SFU grades 3 vs. 4 (p < 0.05). SFU grade 3 and 4 patients who underwent pyeloplasty had longer renal length in comparison to those who were managed conservatively (p < 0.02). This is the first study that evaluates these objective, quantifiable sonographic renal parenchymal measurements in children with unilateral UPJO. These sonographic renal parenchymal measurements correlate closely with worsening of hydronephrosis graded by the SFU and APRPD classification systems. Prospective studies are needed to elucidate the role of sonographic renal parenchymal measurements in the management of children with UPJO.
Highlights
Ureteropelvic junction obstruction (UPJO) is one of the most common causes of prenatal urinary tract dilation (UTD) in children accounting for up to 30% of cases [1]
Patients with other causes of UTD and those with UPJO who did not meet the aforementioned inclusion criteria were excluded from the study
A total of 104 patients with unilateral UPJO underwent a total of 244 renal and bladder ultrasound (RBUS) with 488
Summary
Ureteropelvic junction obstruction (UPJO) is one of the most common causes of prenatal urinary tract dilation (UTD) in children accounting for up to 30% of cases [1]. Standard work-up for postnatal UTD secondary to UPJO includes renal and bladder ultrasound (RBUS), voiding cystourethrogram (or radionuclide cystography), and radionuclide renography. The most widely accepted sonographic measurement systems to assess UTD are the semi-quantitative society of fetal urology (SFU) hydronephrosis grading system [2] and the quantitative anterior–posterior renal pelvic diameter (APRPD) [3,4,5]. These grading systems do not demonstrate ideal interobserver reproducibility [1]. The search for alternate methods of evaluation and follow-up of postnatal UTD has been ongoing. A novel approach to evaluate the kidney using sonographic renal parenchymal measurements was presented by Kadioglu in 2010, who measured normal sonographic renal parenchymal measurements in healthy children [6]
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