Prevalence Of Hydronephrosis Research Articles

Test characteristics of point-of-care ultrasonography in patients with acute kidney injury

BackgroundAcute kidney injury is a common disorder that is associated with significant morbidity and mortality. Point-of-care ultrasonography (PoCUS) is an imaging modality performed at the bedside and is used to assess for obstructive causes of acute kidney injury. Little is known about the test characteristics of PoCUS in patients with acute kidney injury.ObjectiveOur primary objective was to describe the test characteristics of PoCUS for the detection of hydronephrosis in patients presenting with acute kidney injury at our centre. Our secondary objective was to describe the current rate of use of PoCUS for this indication.ResultsIn total, 7873 patients were identified between June 1, 2019 and April 30, 2021, with 4611 meeting inclusion criteria. Of these, 94 patients (2%) underwent PoCUS, and 65 patients underwent both PoCUS and reference standard, for a total of 124 kidneys included in our diagnostic accuracy analysis. The prevalence of hydronephrosis in our cohort was 33% (95% CI 25–41%). PoCUS had a sensitivity of 85% (95% CI 71–94%) and specificity of 78% (95% CI 68–87%) for the detection of hydronephrosis.ConclusionWe describe the test characteristics of PoCUS for the detection of hydronephrosis in a cohort of patients with acute kidney injury. The low uptake of this test presents an opportunity for quality improvement work to increase its use for this indication.

Association of Severity and Type of Pain with Urolithiasis in Adults: A Computed Tomography Urographic Study

Background: Urolithiasis, a prevalent urological condition, especially in areas with warm and dry climates, poses significant healthcare challenges. In Pakistan, part of the "stone-forming belt," the incidence of urolithiasis is consistent with global prevalence rates. Understanding the demographic and clinical presentation patterns is essential for improving diagnostic and treatment strategies. Objective: The study aimed to determine the prevalence and characteristics of asymptomatic urolithiasis in adult patients and to evaluate the efficacy of multidetector computed tomography (MDCT) in detecting urinary tract stones and associated abnormalities. Methods: This cross-sectional study was conducted over four months at the University of Lahore Teaching Hospital's Radiology Department. A total of 112 adult patients aged between 18 to 70 years with symptoms indicative of urinary tract abnormalities were included using a convenience sampling technique. Siemens 64-slice MDCT was employed for diagnosis. The chi-square test and Fisher's Exact Test were utilized for statistical analysis to assess the association between urolithiasis and clinical symptoms, with p-values less than 0.05 considered significant. Results: Out of 112 patients, the prevalence of asymptomatic stones was 2.8%. Bladder stones were identified in 16 patients (14.3%) with a size range of 3-12 mm (mean 7.5 mm, S/D ratio 2.6). Ureteric stones were found in a subset of patients, with sizes ranging from 6-28 mm (mean 13.8 mm, S/D ratio 4.1). The prevalence of hydronephrosis was 39.9% for the left kidney, 26.1% for the right kidney, and 10.9% for bilateral presentation. Non-stone-related findings requiring treatment were identified in 14% of patients undergoing MDCT for renal colic. Conclusion: The study confirmed the prevalence of urolithiasis within the expected range for a high-risk geographic area. MDCT urography proved to be a valuable diagnostic tool in detecting not only urolithiasis but also other significant renal tract abnormalities. The results indicate a need for improved public health strategies, particularly for the at-risk older adult population.

1094: UTILITY OF RENAL ULTRASOUND IN GUIDING MANAGEMENT OF ACUTE KIDNEY INJURY

Introduction: Although guidelines recommend renal ultrasound in patients with acute kidney injury (AKI) to assess for obstructive etiologies, several studies have suggested that the clinical utility of renal ultrasound for all patients with AKI is undetermined and should be reserved for patients with risk factors for urinary tract obstruction. We looked into the characteristics of patients with a radiology-performed renal ultrasound (radiology US) for AKI to evaluate the frequency of unnecessary exams. Methods: We conducted a retrospective chart review from 6/1/2021 to 6/1/2022 at a single urban teaching hospital of patients admitted to medicine, intensive care unit or cardiac care unit with a rardiology US performed for AKI. We collected baseline demographic data, ultrasound findings, interventions including urethral catheter placement, urologic procedures or hemodialysis (HD), and time from ultrasound order to result. Results: 108 patients were included in this study. The average age was 70.2+- 14.52 and 37% were women. Patients were of diverse race/ethnicity: 22% White, 24% Black, 20% Hispanic and 12% Asian. Nephrology was consulted in 67.6%. KDIGO criteria was met in 80.6%; others had unknown baseline creatinine or had chronic kidney disease. 14 patients (n=14/108, 12%) had a final diagnosis of obstructive AKI. Of these patients, hydronephrosis was initially diagnosed on CT for 4 cases (n=4/35, 11%) and POCUS for 3 patients (n=3/8, 0.375%), and radiology US for 7 patients. Of the 11 patients who had hydronephrosis in radiology US, 4 patients had a foley placed prior to ultrasound. Only 3 out of the 11 patients required urological intervention and 1 started HD. Time from AKI detection to ordering radiology US was median 1 day [IQR 1,3] and time from radiology US order to final report was 16.97 hours [IQR 4.89, 27.39]. Conclusions: Out of 108 patients who had a radiology US for AKI, only 8 patients resulted in a change in management, specifically placement of a foley. In addition, 7 patients had hydronephrosis diagnosed on an alternate imaging study. Our study showed that it takes approximately 2 days for radiology US to result. Prevalence of hydronephrosis was low and few had change in management. Moreover, our study suggests that alternative imaging for AKI may result earlier than radiology renal US.

Long-Term fate of the upper urinary tract and ITS association with continence in exstrophy patients

Scarce data is available in literature about the upper urinary tract outcomes of patients with Exstrophy-Epispadias Complex (EEC). After bladder closure during childhood, EEC bladders can become hostile to the upper tracts after bladder by exposing them to high pressures, leading to hydronephrosis (HN) and kidney damage. Similarly, vesicoureteral reflux (VUR) may be present and increase the likelihood for pyelonephritis. We sought to assess long-term upper urinary tract outcomes by evaluating renal function, HN and VUR; and to assess if upper urinary tract outcomes are associated with continence status. A retrospective review of EEC patients having ≥1 surger(y) (ies) at our institution from 1990 until 2019 was performed. Renal function was assessed by evaluating last available estimated glomerular filtration rate (eGFR) and creatinine values. HN was assessed on ultrasound and classified according to the SFU-classification. Patients with recurrent febrile urinary tract infections (UTI) or pyelonephritis underwent a voiding-cystourethrogram (VCUG) assessing VUR, graded following the 'International system of radiographic grading of VUR'. Descriptive and comparative statistical analysis were performed to assess if upper tract outcomes are associated with continence status. Forty-eight patients (75% male) had a median (IQR) follow-up of 18 (10-21) years. The table shows upper tract outcomes for the entire group and stratified by continence status. The median creatinine was 0.6 (0.2-0.9) mg/dL and median eGFR was 108 (72-160) mL/min/1.73m [2]. In two patients (4.2%), HN (SFU-grade 2) was detected. Thirty-six patients (75%) underwent VCUG, revealing high-grade VUR (stage IV-V) in 8 patients (17%) and low-grade VUR (stage I-III) in 7 patients (15%). Continence was associated with a higher need for VCUG (p=0.02) and a higher presence of VUR (p=0.03). Renal function in EEC patients and non-EEC patients is comparable when age matched. Only 6% had low-grade HN which was asymptomatic. 17% had high-grade VUR, which is little compared to literature (40-70%). However, results in literature are described in patients with a 'one-stage' bladder closure, whereas some of our patients had a 'two-stage' procedure. A one-stage procedure creates higher bladder pressures resulting in higher VUR-rates. Statistical analysis has showed that continence is associated with a higher prevalence of recurrent febrile UTI's or pyelonephritis and of VUR. No statistically differences were found between continent and incontinent patients concerning creatinine and eGFR value (p=0.52 and p=0.29), nor in the prevalence of hydronephrosis (p=0.36). However, results of this study suggest that continent patients may portend a higher risk of upper tract deterioration with recurrent febrile UTI's and pyelonephritis due to VUR. Close monitoring of the upper tract status is therefore as important as focus on continence. Large-scale prospective studies defining renal function as well as pyelonephritis rates are needed to optimize the management of the upper tracts in EEC patients.

Impact of double J stenting or nephrostomy placement during transurethral resection of bladder tumour on the incidence of metachronous upper urinary tract urothelial cancer

BackgroundWhether or not double J (DJ) stenting during transurethral resection of a bladder tumour (TURBT) harms patients with regard to possible metachronous upper urinary tract urothelial cancer (UUTUC) development remains controversial. This study evaluated the impact of DJ compared to nephrostomy placement during TURBT for bladder cancer (BCa) on the incidence of metachronous UUTUCs.MethodsWe retrospectively analysed 637 patients who underwent TURBT in our department between 2008 and 2016. BCa, UUTUC and urinary drainage data (retrograde/anterograde DJ and percutaneous nephrostomy) were assessed, along with the prevalence of hydronephrosis, and mortality. Chi-square and Fisher’s exact test was performed for univariate analyses. Survival analysis was performed by the Kaplan-Meier method and log-rank tests.ResultsUUTUC was noted in 28 out of 637 patients (4.4%), whereas only eight (1.3%) developed it metachronously to BCa. Out of these, four patients received DJ stents, while four patients received no urinary drainage of the upper urinary tract. Placement of urinary drainage significantly correlated with UUTUC (50.0% vs. 17.9%; p = 0.041). DJ stenting significantly correlated with UUTUC (50.0% vs. 11%; p < 0.01), while no patient with a nephrostomy tube developed UUTUC. UUTUC-free survival rates were significantly lower for patients with DJ stents than for all other patients (p = 0.001). Patients with or without DJ stents had similar overall survival (OS) rates (p = 0.73), whereas patients with nephrostomy tubes had significantly lower OS rates than all other patients (p < 0.001).ConclusionsPatients with DJ stenting during TURBT for BCa might have an increased risk of developing metachronous UUTUC. This study indicated advantages in placing nephrostomy tubes rather than DJ stents; however, confirmation requires investigation of a larger cohort. Even so, the increased mortality rate in the nephrostomy group reflected hydronephrosis as an unfavourable prognostic factor.

Megaesophagus Is a Major Pathological Condition in Rats With a Large Deletion in the Rbm20 Gene.

A spontaneously arising, loss-of-function mutation in the RNA binding motif protein 20 (Rbm20) gene, which encodes a nuclear splicing protein, was previously identified as the underlying reason for expression of an abnormally large TITIN (TTN) protein in a rat model of cardiomyopathy. An outbreak of Pseudomonas aeruginosa led to submission of rats with dyspnea, sneezing, lethargy, nasal discharge, and/or unexpected death for diagnostic evaluation. Necropsy revealed underlying megaesophagus in Rbm20–/– rats. Further phenotyping of this rat strain and determination of the size of esophageal TTN was undertaken. The Rbm20-defective rats developed megaesophagus at an early age (26 weeks) with high frequency (13/32, 41%). They also often exhibited secondary rhinitis (9/32, 28%), aspiration pneumonia (8/32, 25%), and otitis media/interna (6/32, 19%). In addition, these rats had a high prevalence of hydronephrosis (13/32, 41%). RBM20 is involved in splicing multiple RNA transcripts, one of which is the muscle-specific protein TTN. Rbm20 mutations are a significant cause of dilated cardiomyopathy in humans. In Rbm20-defective rats, TTN size was significantly increased in the skeletal muscle of the esophagus. Megaesophagus in this rat strain (maintained on a mixed genetic background) is hypothesized to result from altered TTN stretch signaling in esophageal skeletal muscle. This study describes a novel mechanism for the development of megaesophagus, which may be useful for understanding the pathogenesis of megaesophagus in humans and offers insights into potential myogenic causes of this condition. This is the first report of megaesophagus and other noncardiac pathogenic changes associated with mutation of Rbm20 in any species.

Prevalence of Hydronephrosis and Surgery Results in Patients with Pelvic Organ Prolapse

Prevalence of Hydronephrosis and Surgery Results in Patients with Pelvic Organ Prolapse

Effect of pessary use on hydronephrosis in women with advanced pelvic organ prolapse: a self-selected interventional trial.

The purpose of this study was to determine the proportion of women who demonstrate improvement in hydronephrosis after pessary placement for advanced pelvic organ prolapse (POP). This was a planned subset analysis of a prospective study on the prevalence of hydronephrosis in women with advanced POP. Women with anterior or apical POP ≥1cm past the hymenal remnant were enrolled and screened for hydronephrosis. All were offered expectant management, pessary placement or surgery. Participants self-selecting pessary placement were compared with those with expectant management during the study period. A follow-up ultrasound scan was performed after >3weeks of treatment. The proportions of participants demonstrating cure/improvement were compared using Fisher's exact test. Of 180 participants enrolled, 55 had hydronephrosis for a prevalence of 30.6% (95% CI 24.3-37.6%). Of those with hydronephrosis, 39 (70.8%) chose pessary placement while 16 (30.2%) declined. A follow-up ultrasound scan was performed in 89% of participants at a median of 77days (interquartile range 49-99days). Intention-to-treat analysis showed no difference in improvement or resolution of hydronephrosis between women who accepted and those who declined pessary placement (p = 0.43). However, of 22 women successfully using a pessary, 77.3% showed improvement or cure, compared with 29.6% of 27 women not using a pessary (p = 0.003). Successful pessary use improved hydronephrosis in over 75% of women with advanced POP. Approximately 39% of women with prolapse did not comply with pessary use and did not demonstrate hydronephrosis improvement.

Is Hydronephrosis a Complication after Anterior Lumbar Surgery?

Study Design Prospective follow-up design. Objective Ureteral injury is a recognized complication following gynecologic surgery and can result in hydronephrosis. Anterior lumbar surgery includes procedures like anterior lumbar interbody fusion (ALIF) and total disk replacement (TDR). Anterior approaches to the spine require mobilization of the great vessels and visceral organs. The vascular supply to the ureter arising from the iliac arteries may be compromised during midline retraction of the ureter, which could theoretically lead to ureter ischemia and stricture with subsequent hydronephrosis formation. Methods Potential candidates with previous ALIF or TDR via anterior retroperitoneal access between January 2008 and March 2012 were chosen from those operated on by a single surgeon in a university hospital setting (n = 85). Renal ultrasound evaluation of hydronephrosis was performed on all participants. Simple descriptive and inferential statistics were used to generate results. Results A total of 37 voluntary participants were recruited (23 male, 14 female subjects; average age 51.8 years). The prevalence of hydronephrosis in our population was 0.0% (95% confidence interval 0 to 8.1%). Conclusions Retraction of the ureter across the midline in ALIF and TDR does not result in an increase in hydronephrosis and appears to be a safe surgical technique.

Re: Prevalence of Hydronephrosis in Women with Advanced Pelvic Organ Prolapse

Re: Prevalence of Hydronephrosis in Women with Advanced Pelvic Organ Prolapse

A prospective study on the prevalence of hydronephrosis in women with pelvic organ prolapse and their outcomes after treatment

This work aims to study the prevalence of hydronephrosis and its associated factors in women with pelvic organ prolapse (POP) and to assess the effect on hydronephrosis following treatment for POP. In this prospective observational study, 233 patients with POP were staged by the Pelvic Organ Prolapse-Quantification system, followed by sonographic measurement of bilateral renal pelvis to identify presence of hydronephrosis. Follow-up scan for hydronephrosis was performed after patients were treated for the POP. The prevalence of hydronephrosis was 10.3% (95% confidence interval (CI), 6% and 14%). Although patient's age, higher parity, and the presence of diabetes mellitus and hypertension were more common in the group with hydronephrosis, logistic regression analysis indicated that only the severity of POP was an independent risk factor for hydronephrosis. The odds ratio in stages 3 to 4 POP for hydronephrosis was 3.4 (95% CI, 1.3 and 9.2). Hydronephrosis resolved in 95% of patients after they received treatment for POP. The prevalence of hydronephrosis was 10.3% in patients with POP and patients with stages 3 to 4 POP were at particular higher risk. Hydronephrosis resolved in most of the patients after treatment for the prolapse.

Curbing the Use of Ultrasonography in the Diagnosis of Acute Kidney Injury: Penny Wise or Pound Foolish?

Curbing the Use of Ultrasonography in the Diagnosis of Acute Kidney Injury: Penny Wise or Pound Foolish?

Validation of emergency physician ultrasound in diagnosing hydronephrosis in ureteric colic

Patients presenting to the ED with obstructive nephropathies benefit from early detection of hydronephrosis. Out of hours radiological imaging is expensive and disruptive to arrange. Emergency physician ultrasound (EPU) could allow rapid diagnosis and disposition. If accurate it might avert the need for formal radiological imaging, exclude an obstruction and improve patient flow through the ED. This was a prospective study of a convenience sample of all adult non-pregnant patients with presumed ureteric colic attending the ED with prior ethics committee approval. An emergency physician or registrar performed a focused ultrasound scan and were blinded to the patient's other management. A computerized tomography scan was also performed for all patients while in the ED or within 24 h of the EPU. The accuracy of EPU detection of hydronephrosis was determined; using computerized tomography scans reported by a senior radiologist as the 'gold-standard'. Sixty-three patients with suspected ureteric colic were enrolled of whom 57 completed both EPU and computerized tomography imaging. Forty-nine had confirmed nephrolithiasis by computerized tomography with 39 having evidence of hydronephrosis. Overall prevalence of hydronephrosis was 68% (95% confidence interval [CI] 56-79%); compared with computerized tomography, EPU had a sensitivity of 80% (95% CI 65-89%); specificity of 83% (95% CI 61-94%); positive predictive value of 91% (95% CI 75-98%) and negative predictive value of 65% (95% CI 43-83%). The overall accuracy was 81% (95% CI 69-89%). Although the accuracy of detection of hydronephrosis after focused training in EPU is encouraging, further experience and training might improve the accuracy of EPU and allow its use as a screening tool.

Prevalence of hydronephrosis in patients with genital prolapse

Objective: To determine the prevalence of hydronephrosis in patients with genital prolapse and evaluate contributing factors. Methods: Retrospective study of the records of 189 patients with pelvic organ prolapse who underwent preoperative renal imaging studies. Results: Of the 189 patients 31 (17.4%) had hydronephrosis; in 20 (10.6%) patients the hydronephrosis was mild, in 7 (3.7%) it was moderate and in 4 (2.7%) it was severe. The patients with hydronephrosis were older (mean age 68±9.5 SD vs. 60.5±10.8 SD, P<0.001) had a higher creatinine levels (0.84±0.4 SD vs. 0.78±0.3 SD P<0.005) and had a higher degree of uterine prolapse (mean 2.6±0.9 SD vs. 1.1±1.2 SD, P<0.005). After adjusting for age and type of prolapse, only patients with uterine prolapse remained significantly more likely to suffer from hydronephrosis (adjusted odds ratio 1.9, 95% CI 1.1, 3.2). Conclusion: The prevalence of hydronephrosis in patients with genital prolapse is appreciable and is related primarily to degree of uterine prolapse.

Utility of ultrasound of the upper urinary tract in elderly men with indicators of obstructive symptoms or abnormal flow: how often can silent hydronephrosis be detected in general practice?

While the prevalence of hydronephrosis is very low in obduction studies, a prevalence of 3-13% is reported for patients with an obstruction who are listed for prostatectomy. In order to evaluate the usefulness of transabdominal ultrasound in primary care, we determined the occurrence of hydronephrosis in males with symptoms of urinary obstruction in a general practice setting. A micturition questionnaire (a modified Boyarsky) was sent to all men of 55 years or more who were registered in 10 general practices in Maastricht, and was followed by an examination at their general practice. Men with obstructive symptoms and/or with a free-flow abnormality were examined in the hospital with transabdominal ultrasound in order to detect dilatation of the upper urinary tract. This ultrasound was repeated approximately 15 months later. At the first measurement, none of the examined men (n = 178) had hydronephrosis, and this was still the case for 94 men 15 months later. Renal ultrasound is not necessary in general practice for men with uncomplicated obstructive complaints.

Prevalence of hydronephrosis in patients undergoing surgery for pelvic organ prolapse: Beverly C.M.; Walters M.D.; Weber A.M.; Piedmonte M.R.; Ballard L.A. USA Obstet Gynecol 1997 90/1 (37–41)

Prevalence of hydronephrosis in patients undergoing surgery for pelvic organ prolapse: Beverly C.M.; Walters M.D.; Weber A.M.; Piedmonte M.R.; Ballard L.A. USA Obstet Gynecol 1997 90/1 (37–41)

Prevalence of hydronephrosis in patients undergoing surgery for pelvic organ prolapse

To determine the prevalence of hydronephrosis in patients undergoing surgery for pelvic organ prolapse and to determine whether hydronephrosis is associated with the type and severity of prolapse. The charts of 375 consecutive patients undergoing surgery for pelvic organ prolapse at the Cleveland Clinic Foundation between January 1, 1990, and December 31, 1993 were reviewed. Preoperative renal ultrasounds and intravenous pyelograms (IVP) were evaluated for hydronephrosis based on the final diagnosis established by the radiologists. The severity of prolapse was determined from the preoperative office examination or from the examination under anesthesia at the time of surgery. Of 375 patients, 323 had either a preoperative renal ultrasound or IVP. The mean age was 66.0 +/- 10.2 years (range 35-93) and median parity was 3.0 (range 0-10). Of the 323 patients, 25 (7.7%, 95% confidence interval 5, 11) had hydronephrosis. Thirteen patients (4.0%) had mild hydronephrosis, nine (2.8%) had moderate hydronephrosis, and three (0.9%) had severe hydronephrosis. The prevalence of hydronephrosis increased with increasing severity of prolapse. Two patients with hydronephrosis had evidence of renal insufficiency (creatinine > or = 1.6), and both had severe bilateral hydronephrosis and complete procidentia. The prevalence of hydronephrosis was lower in patients with vaginal vault prolapse versus uterine prolapse (3.9% compared with 12.6%, P < .01), The prevalence of hydronephrosis in patients undergoing surgery primarily for pelvic organ prolapse is low, increases with worsening pelvic organ prolapse, and is lower in patients with vaginal vault prolapse that in those with uterine prolapse.